Introduction to Clinical Neurology, ed 2.

Introduction to Clinical Neurology, ed 2 Gelb DJ. Woburn, MA 01801, Butterworth-Heinemann, 2000, paperback, 416 pp, illus, ISBN: 0-75067202-1, $35.

The author's purpose for this book is to present a systematic approach to the neurologic problems that are likely to be encountered in general medical practice. The author also states that the book focuses on the practical issues of patient management. I must admit that when I first looked at this book, I was skeptical of its depth. After all, my copy of Adam's Principles of Neurology is about 1,600 pages. However, as I started to read Gelb's text I was impressed by the content. This book is not a comprehensive text, but it is, in my opinion, an excellent discussion of clinical problem solving in neurology.

The book has 18 chapters (12 chapters were written by Gelb, 6 chapters were written by Gleb and a contributor), covering basic topics such as the neurologic examination and then discussing common neurologic problems such as stroke, seizures, neuromuscular disorders, dementing illnesses, movement disorders, sleep disorders, and pediatric and geriatric neurology. The book also discusses common symptoms such as changes in mental status, headache, vision, equilibrium, back and neck pain, and incontinence. Each chapter only provides an overview of each clinical entity, not an in-depth discussion.

Each chapter begins with a series of questions and case histories on a particular topic, followed by a discussion of the topic. Using this technique, the author leads the reader through a systematic approach of analyzing signs and symptoms associated with each of the major neurological problems. The author provides the reader with general information and medical management of the disease. For example, in the chapter on stroke, Gelb and a contributor, Marc Chimowitz, list 3 case histories and ask questions regarding the signs and symptoms, patient management, special tests, and intervention. They then provide background information on stroke, including pathophysiology, medical management, rehabilitation (physical therapy is only mentioned briefly), risk factors, types of stroke, prevention, and treatment. The authors end the chapter with a brief discussion of each case.

For me, the highlight of the book was in the first 3 chapters: "Where's the Lesion?," "The Neurologic Examination," and "What's the Lesion?" "Where's the Lesion?" leads the reader through a systematic routine for locating a lesion in the nervous system. Gelb treats the topic as an "intellectual game," stating the rules of play and how to play. This chapter would be especially helpful for students because it outlines how to tie together the anatomical pathways with the patient's signs and symptoms. There are a number of diagrams that proceed from more detailed anatomical pathways to schematic drawings of the pathways. Having taught this approach to locating lesions for many years, I think that this chapter would be valuable not only to physical therapist students learning about neurology but also for faculty who want to gain insight on teaching a systematic approach to problem solving.

The chapter on the neurologic examination gives complete coverage to a "typical" examination and offers the student very practical advice about performing the examination and interpreting the results. In "What's the Lesion?," Gelb and James Albers discuss temporal factors in neurologic disease, relating the time course to different types of diseases (eg, neoplasm versus stroke).

Overall, I was impressed by the book. It is not a comprehensive textbook of neurological diseases. It does not discuss neurological problems in great detail. It does, however, teach the reader how to approach neurological problems with an emphasis on the location of the lesion. It discusses important issues about the more common neurological diseases, and it is written in an "easy" style that will appeal to students.

The text contains some line drawings, but no photographs. The editor does not include a bibliography nor are there any references cited. The text would be appropriate for physical therapist students and faculty, but probably not for physical therapist assistants. Any physical therapist faculty member teaching a course in neurology or neuroscience should look at this book.

Thomas M Mohr, PT, PhD University of North Dakota Grand Forks, ND

Dr Mohr is Professor and Chairman in the Department of Physical Therapy. He teaches courses in neuroscience, physiology, biomechanics, and electrophysiology. His research interests are in electromyography, biomechanics, and electrotherapy.