Bradley’s Neurology in Clinical Practice, 2-Volume Set 6E

Bradley's Neurology in Clinical Practice, 2-Volume Set 6E

Neurology in Clinical Practice brings you the most current clinical neurology through a comprehensive text, detailed color images, and video demonstrations. Drs. Daroff, Fenichel, Jankovic and Mazziotta, along with more than 150 expert contributors, present coverage of interventional neuroradiology, neurointensive care, prion diseases and their diagnoses, neurogenetics, and many other new developments. Online at, you’ll have access to a downloadable image library, videos, and the fully searchable text for the dynamic, multimedia content you need to apply the latest approaches in diagnosis and management.

Find answers easily through an intuitive organization by both symptom and grouping of diseases that mirrors the way you practice.Diagnose and manage the full range of neurological disorders with authoritative and up-to-date guidance. Refer to key information at-a-glance through a full-color design and layout that makes the book easier to consult.Access the fully searchable text online at, along with downloadable images, video demonstrations, and reference updates. Stay current on advances in interventional neuroradiology, neurointensive care, prion diseases, neurogenetics, and more. See exactly how neurological disorders present with online videos of EEG and seizures, movement disorders, EMG, cranial neuropathies, disorders of upper and lower motor neurons.
Keep up with developments in the field through significant revisions to the text, including brand-new chapters on neuromodulation and psychogenic disorders and a completely overhauled neuroimaging section.Tap into the expertise of more than 150 leading neurologists―50 new to this edition.Don’t fall behind the advances in clinical neurology – use Bradley’s multimedia content and get ahead

The first ideas that led to Neurology in Clinical Practice(NICP) The first ideas that led to Neurology in Clinical Practice(NICP) originated in Newcastle upon Tyne in the mid-1970s. Professor John Walton—now Lord Walton of Detchant, then professor  of  neurology  and  dean  of  the  university’s  medical school—and several of us on the faculty believed we should write  a  Newcastle  neurology  textbook.  We  decided  that  the first  section  would  describe  how  experienced  neurologists approach common neurological conditions such as headache, walking difficulty, loss of vision, and so on. The second section would  deal  with  neurological  investigations  such  as  neurophysiology  and  neuroimaging.  The  third  section  would provide  an  introduction  to  related  neuroscience  disciplines such  as  neurogenetics  and neuroimmunology.  The  fourth section would outline the principles of management of neurological  conditions,  and  the  fifth  would  cover  all  the  individual neurological diseases. The textbook would be divided into two volumes, with volume I containing the first four sections and volume II the neuro logical diseases.The “Newcastle  textbook”  never  got  beyond  the  planning stage,  and  in  1977  I  moved  to  Tufts  New  England  Medical Center. There I started the journal, Muscle and Nerve, and was its founding editor for 10 years. However, the concept of an innovative  practical  textbook  of  neurology  remained  at  the back of my mind. The opportunity to return to this project presented  itself  in  1987  when  a  small  medical  publisher approached  me  to  write  a  book  about  neurology.  A  multiauthor textbook of the magnitude that I conceived needed at least four editors who were not only clinicians and research workers with expertise in the major neurological subspecialties, but who were also established leaders across the breadth of neurology. I approached Bob Daroff, Gerry Fenichel, and David  Marsden—all  giants  in  the  field—and  they  agreed  to join me in this project.We chose the title, Neurology in Clinical Practice, because we wanted the book to be used not only by neurologists in training and practice but also by others whose specialties border upon neurology,  such  as  internists  and  neurosurgeons.  Together, Bob, Gerry, David, and I selected the authors for the 84 chapters that made up the first edition and laid out guidelines for the chapter, its content, and format. We set tough time schedules, and Bob Daroff, in particular, ensured that our authors met the deadlines. All four editors reviewed the manuscript for every submitted chapter to ensure uniformity of style and content.During  this  time,  the  small  medical  publishing  company was bought by Houghton Mifflin, which was then acquired by Butterworth  (later  Butterworth-Heinemann),  which  eventually became part of the Elsevier group. Nancy Megley was the publishing editor with Butterworth for the first edition. The fact that NICP was published at the end of 1990 with a 1991 copyright is proof of the support we had from our contributors and Butterworth.We devoted a great deal of attention to the technical aspects of textbook production. For instance, we wished to have the highest  quality  reproduction  of  halftone  illustrations  and chose  top-quality  china  clay  paper  for  the  book.  The  first edition,  divided  into Volume  I,  Principles  of  Diagnosis  and Management,  and  Volume  II,  The  Neurological  Disorders, encompassed 1941 pages plus 88 pages of index and weighed 16  pounds;  we  may  have  been  responsible  for  a  number  of hernias among our readers. The first edition of NICP received the Most Outstanding Book award for 1991 from the Association of American Publishers and was greeted with very favorable reviews by all the neurological journals. It soon established itself as a leading international textbook of neurology.Wishing to keep NICP up to date, we published the second edition in 1996. We were fortunate to be joined by Susan Pioli, then  director  of  medical  publishing  for  ButterworthHeinemann and later neurology publisher for Elsevier. Susan continued to work with us through the fifth edition. For the second edition, we selected a number of new authors, and the text  was  completely  rewritten.  In  editing  it,  we  embraced the digital age and went electronic with an added CD version. The five sections were merged into three: Part 1, Approach to Common Neurological Problems; Part 2, Neurological Investigations  and  Related  Clinical  Neurosciences;  and  Part  3, Neurological Diseases. By slightly reducing the grade of paper, we  were  able  to  produce  a  lighter  book  and  accommodate much new material in 2128 pages plus a 117-page index. We also produced the Pocket Companion to Neurology in Clinical Practice, Second Edition,which was almost entirely the work of Gerry Fenichel. It became very popular with residents, who came to refer to it as “the Baby Bradley.”For the third edition (published in 2000), besides recruiting new authors and adding new material, we persuaded Butterworth-Heinemann  to  publish  NICP  online,  and  it  became the  first  major  neurology  textbook  to  be  available  in  that format.  Our  initial  discussions  had  revolved  around  how much  material  we  could  get  onto  a  CD—at  that  time,  500 MB was the maximum capacity—but that was enough space to include only the text and not the illustrations. In the end, we  leapfrogged  straight  into  online  publishing  with,  thereby  allowing  us  to  add  much  more content,  particularly  videos  of  electroencephalograms,  electromyograms, and eye movements. Tragically, we were in the final  stages  of  production  on  the  third  edition  when  David Marsden  died;  that  edition  was  dedicated  to  his  memory.For  the  fourth  edition,  published  in  2004,  we  invited  Joe Jankovic to join us in David’s place. Joe brought his expertise in movement disorders and was responsible for adding videos of  these  fascinating  conditions  to This unparalleled teaching tool greatly expanded the educational role of NICP. Following the publication of our fourth edition, in collaboration with Karl Misulis, we launched the Review  Manual  for  Neurology  in  Clinical  Practice,  a  book  of questions and answers intended as an introduction to board examinations.Foreword xiiiButterworth-Heinemann  completely  revamped  the  fifth edition  of  NICP,  published  in  2008.  It  was  printed  in  color with  completely  redrawn  figures  to  bring  it  into  line  with standard  textbook  format.  Again,  with  rigorous  editing  we incorporated  much  new  material  and  removed  out-of-date work. Despite the major explosion of knowledge in the clinical and  basic  neurosciences  in  the  previous  17  years,  the  NICP fifth edition had expanded to only 2488 pages.In  the  22  years  since  the  first  publication  of  NICP,  it  has become  the  major  international  textbook  of  neurology  and been  translated  into  Spanish,  Italian,  Polish,  and  Turkish. When  making  academic  visits  to  medical  centers  in  other countries, I have found myself lauded as an editor of “the bible, Neurology in Clinical Practice.” I know that Bob Daroff, Gerry Fenichel, and Joe Jankovic have had the same experience.When  I  stepped  down  as  chair  of  the  Neurology  Department at the University of Miami in 2007, I decided it was time to move on to other interests and retire from the editorship of NICP. It had been an exciting and satisfying 20 years, and editing each new edition provided me personally with a complete neurological update course. For this, the sixth edition of NICP,  my  editorial  colleagues  and  the  publishers  have  been fortunate  to  persuade  John  Mazziotta  to  take  my  place.  He brings  a  wealth  of  knowledge  about  the  expanding  field  of functional  imaging  of  the  nervous  system.  The  NICP  sixth edition retains the structure of the textbook that was conceptualized nearly 40 years ago in Newcastle, but the clinical and scientific  contents  remain  ever  new.  I  have  no  doubt  of  the continuing success of our textbook and wish it well

Neurology in Clinical Practice is a practical textbook of neurology that covers all the clinical neurosciences and provides not Neurology in Clinical Practiceis a practical textbook of neurology that covers all the clinical neurosciences and provides not only  a  description  of  neurological  diseases  and  their  pathophysiology but also a practical approach to their diagnosis and management.  In  the  preface  to  the  1991  first  edition  of  this book,  we  forecasted  that  major  technological  and  research advances would soon reveal the underlying cause and potential  treatment  of  an  ever-increasing  number  of  neurological diseases.The  20  years  that  have  passed  since  that  prediction  have been  filled  with  the  excitement  of  new  discoveries  resulting from  the  blossoming  of  neurosciences.  Clinical  neuroscience  has  taken  on  the  important  and  challenging  problems of  neuroprotection  in  both  neurodegenerative  disorders and  acute  injuries  to  the  nervous  system,  such  as  stroke, multiple  sclerosis,  and  trauma.  In  line  with  this  effort, basic  science  progress  in  areas  of  neuroplasticity  and neural  repair  are  yielding  important  results  that  should translate  into  clinical  utility  in  the  near  future.  Advances in  the  genetics  of  neurological  diseases  have  not  only  facilitated  genetic  testing  but  also  provided  important  insights into  the  pathogenesis  of  diseases  and  helped  identify potential  therapeutic  targets.  Significant  advances  have taken  place  in  the  management  of  patients  with  both  ischemic  and  hemorrhagic  stroke.  When  the  first  edition  of this  textbook  was  published,  there  was  essentially  no  effective  means  of  treating  acute  ischemic  stroke.  Today  we have  numerous  opportunities  to  help  such  patients,  and  a campaign  has  begun  to  educate  the  general  public  about the  urgency  of  seeking  treatment  when  stroke  symptoms occur.The  advent  of  teleneurology  is  also  beginning  to  provide treatment for patients who lack access to neurological specialists or whose problems are too complicated for routine management  in  the  community.  Teleneurology  consults  are beginning to be provided nationwide across all subspecialties of our discipline, with a particular emphasis on patients who need  intraoperative  monitoring,  critical  care  neurology,  and stroke interventions.To  the  benefit  of  patients,  clinical  neuroscience  has partnered  with  engineering.  Neuromodulation  has  become an  important  part  of  clinical  therapy  for  patients  with movement  disorders  and  has  applications  in  pain  management  and  seizure  control. Along  these  same  lines,  braincontrolled  devices  will  soon  help  provide  assistance  to individuals  whose  mobility  or  communication  skills  are compromised.  Recent  advances  in  optogenetics  have  led to  development  of  techniques  that  allow  exploration  and manipulation  of  neural  circuitry,  which  may  have  therapeutic  applications  in  a  variety  of  neurologic  disorders.Finally,  a  search  for  biomarkers  that  reliably  identify  a preclinical  state  and  track  progression  of  disease  is  a promising  goal  in  many  neurodegenerative  disorders. Neurodegenerative  disease,  Alzheimer  disease  (AD)  in  particular,  continues  to  be  a  worldwide  crisis.  The  financial aspects  associated  with  AD  alone  are  staggering  and  have the  capacity  to  bankrupt  the  modern  world.  For  example, if  no  treatment  or  means  to  delay  AD  is  found  by  2050, the  annual  cost  of  care  for  such  patients  in  the  United States  will  exceed  $1  trillion,  and  the  40-year  interval aggregate  cost  will  exceed  $20  trillion.  The  costs  in  terms of  suffering  and  hardship  for  patients  and  their  families  is too  immense  to  quantify.  As  such,  there  is  an  urgent  need for  basic  and  clinical  neuroscience  to  make  progress  in finding  ways  to  delay  the  onset  of  neurodegenerative  disorders  and,  ultimately,  prevent  them.There  is  evidence  of  some  startling  new  advances  in neuroscience  that  are  only  just  being  considered  today.  The engineering  of  nanotechnologies  into  strategies  to  treat patients  with  neurological  disorders  is  just  beginning.  One can  envision  a  future  that  includes  smart  nanoimaging agents, nanopumps that can help regulate deranged circuitry on  a  local  basis,  and  nanostimulators  to  participate  in  the growing  field  of  neuromodulation.  In  addition,  other  partnerships  with  nanoengineers  will  produce  sensors  that  can monitor  not  only  the  external  condition  of  a  patient  by tracking  movements,  vital  signs,  and  sleep  behaviors  but also  internal  states  when  such  sensors  are  developed  on  a nano  scale.We  still  have  a  long  way  to  go  to  reach  the  ultimate  goal of  being  able  to  understand  and  treat  all  neurological  diseases. Neurology remains an intellectually exciting discipline, both  because  of  the  complexity  of  the  nervous  system  and because  of  the  insight  that  the  pathophysiology  of  neurological  disease  provides  into  the  workings  of  the  brain  and mind.  Accordingly,  we  offer  the  sixth  edition  of Neurology in  Clinical  Practice as  the  updated  comprehensive  and  most authoritative  presentation  of  both  the  art  and  the  science of  neurology.For this edition, the text has been completely rewritten, and almost a fifth of the chapters have been prepared by authors new to the cadre of contributors. The layout of the pages has been  completely  redesigned  to  provide  a  user-friendly  environment for accessing the material. The companion website,, has been refined and expanded and includes video and audio material, additional illustrations and references,  and  chapters  on  key  related  material  from  other established neurology texts. It also is regularly updated with minireviews  of  important  new  publications  in  the  neurological literature.A  work  of  this  breadth  would  not  have  been  possible without  the  contributions  of  many  colleagues  throughout the  world.  We  are  deeply  grateful  to  them  for  their  selfless devotion  to  neurological  education.  We  are  also  grateful  to our  Elsevier  counterparts,  Lotta  Kryhl,  content  strategist, and Lucia Gunzel, content development manager, who were Preface xvkey  in  drawing  this  project  together. Additionally,  we  thank Cindy  Thoms,  project  manager,  without  whose  energy  and efficiency  the  high  quality  of  production  and  rapidity  of publication  of  this  work  would  not  have  been  achieved. Finally,  we  gratefully  acknowledge  the  contributions  of  our readers,  whose  feedback  regarding  Neurology  in  Clinical Practice and  the  website  has  been  invaluable  in  enhancing our  educational  goals

Neurological diagnosis is sometimes easy, sometimes quite challenging, and specialized skills are required. If a patient shuffles into the physician’s office, demonstrating a pill-rolling tremor of the hands and loss of facial expression, Parkinson disease comes readily to mind. Although making such a “spot diagnosis” can be very satisfying, it is important to consider that this clinical presentation may have another cause entirely—such as neuroleptic-induced parkinsonism—or that the patient may be seeking help for a totally different neurological problem. Therefore, an evaluation of the whole problem is always necessary.In all disciplines of medicine, the history of symptoms and clinical examination of the patient are key to achieving an accurate diagnosis. This is particularly true in neurology. Standard practice in neurology is to record the patient’s chief complaint and the history of symptom development, followed by the history of illnesses and previous surgical procedures, the family history, personal and social history, and a review of any clinical features involving the main body systems. From these data, one formulates a hypothesis to explain the patient’s illness. The neurologist then performs a neurological examination, which should support the hypothesis generated from the patient’s history. Based on a combination of the history and physical findings, one proceeds with the differential diagnosis to generate a list of possible causes of the patient’s clinical features.
What is unique to neurology is the emphasis on localization and phenomenology. When a patient presents to an internist or surgeon with abdominal or chest symptoms, the localization is practically established by the symptoms, and the etiology then becomes the primary concern. In clinical neurological  practice, however, a patient with a weak hand may have a lesion localized to muscles, neuromuscular junctions, nerves  in the upper limb, brachial plexus, spinal cord, or brain. The formal neurological examination allows localization of the  offending lesion. Similarly, a neurologist skilled in recognizing phenomenology should be able to differentiate between  tremor and stereotypy, both rhythmical movements; among tics, myoclonus, and chorea, all jerk-like movements; and  among other rhythmical and jerk-like movement disorders, such as seen in dystonia. In general, the history provides  the best clues to etiology, and the examination is essential for localization and appropriate disease categorization—all  critical for proper diagnosis and treatment

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