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|Year : 2016 | Volume
| Issue : 2 | Page : 363-364
Differential Diagnosis in Neurology
Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
|Date of Web Publication||3-Mar-2016|
Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shukla R. Differential Diagnosis in Neurology. Neurol India 2016;64:363-4
Editors : Sudesh Prabhakar, Gagandeep Singh
Edition : 1st
Publisher : Jaypee Brothers Medical Publishers Private Ltd., New Delhi
Pages : 557
Neurological diagnosis is most fascinating and mathematical if one follows a systematic approach. Generating a neurologic differential diagnosis can be very challenging and requires a logical and thoughtful approach. Useful treatments now exist for many neurological disorders, which were once considered untreatable, so a skilful approach to diagnosis is essential. Accurate diagnosis emerges from following a step-by-step approach, which in turn guides the rational selection of specific tests. Information elicited through the history and examination is essential not only for localizing the abnormality but also for identifying possible etiologies. A focused neurologic examination based on the hypothesis generated during history taking gives a better yield. The advent of advanced neuroimaging techniques has not diminished the importance of history and clinical examination, as which imaging sequence to order and what scan to perform, still depends on the clinical diagnosis. The book contains 46 chapters written by 81 authors drawn from different parts of the country as well as abroad. The chapters are well written with sufficient figures, algorithms and boxes highlighting the salient points. With more than 350 images and 250 tables, the contents add up to make the book comprehensive and reader friendly.
The book has several strengths. It has been divided into short chapters that provide a comprehensive approach to clinical examination and covers several important areas including approaches to transient loss of unconsciousness and epilepsy, coma, delirium, intellectual and memory impairment, developmental regression, apraxias and agnosias, loss of all modalities of special sensations, headache, movement disorders, ataxia, gait disorders, limb weakness, and bladder and bowel disorders, just to name a few of the important topics covered. Common clinical scenarios such as subarachnoid hemorrhage, neuropathies, muscle diseases, neck and arm pain, backache and limb pain, spinal cord syndromes and craniovertebral junction anomalies, and stroke have also been well-covered. The greatest virtue of this book lies in the well-illustrated, schematic diagrams that nicely portray the anatomical principles and clinical findings in a reader–friendly manner and gives the differential diagnosis in clearly demarcated boxes. A few chapters are very comprehensive and can serve as landmark articles for a bedside referencing of differential diagnosis. For any student of neurology in his/her formative years, this book is invaluable in suggesting algorithms for a systematic evaluation of the varied clinical presentations and a ready reckoner during the times when one is not sure of which direction to pursue when confronted with a case that is difficult to diagnose. A few important references are also quoted at the end of each chapter for further reading. The simple language and the bulleted format facilitate an easy imbibing of the concepts reviewed. The appendix at the end of the book presents simple tools for clinical examination of cognitive functions, and the commonly used clinical grading systems and scales that will be extremely useful for the readers.
There are a few shortcomings such as in the chapter on 'approach to new-onset seizures,' there is no mention of single cysticercus granuloma, which is the most common cause of new-onset seizures in our country; on the other hand, there is a very elaborate table on antibody screening in the blood and cerebrospinal fluid in patients with suspected autoimmune seizures. In the chapter on 'dystonia,' there is just a passing mention of Wilson's disease. Similarly, in the chapter on 'approach to falls,' multiple sclerosis is mentioned as the first cause of falls in the tables giving neurological causes of falls in the young and middle age, respectively. I could also not understand the relevance of the table giving assessment of activities of daily living (Barthel index) in this chapter. The table has also not been referred to in the text of the chapter. The possible reason for those discrepancies may be that all the three chapters have been written by authors working in the United Kingdom.
Subacute sclerosing panencephalitis, which is an important cause of myoclonus in our country, is just mentioned in Box 26.1 giving the 'causes of symptomatic myoclonic etiologies.' In the chapter on 'vertigo,' the HINTS battery is described to exclude an infarct in a patient presenting with isolated vertigo, but I could not find the full form of the mnemonic HINTS (Head Impulse, Nystagmus, Test of Skew). In the chapter on 'hyperkinetic movement disorders' under the heading 'tremors,' lines 5-7 mention, “This is one of the most common myelodysplastic syndromes in the community in our country,” which appears to be out of context. Japanese encephalitis can result in various types of movement disorders as a sequelae but it does not find a mention in the chapters on 'dystonia,' 'hyperkinetic movement disorders' or 'hypokinetic movement disorders.'
Although the book has been published in 2016, the gestation period seems to be long as on page 34 paragraph 2, it is mentioned that “epilepsy can be diagnosed from the second seizure onwards” which is not completely correct as the International League Against Epilepsy in 2014 has proposed a new definition of epilepsy where a diagnosis can be made even after a single seizure. There are several spelling/grammatical mistakes e.g., page 13, in the text below box 1.2 under point 1, “common manifestations of common diseases” should actually be “common manifestations of uncommon diseases.” On page 81, figure 7.1, Cheyne Stokes is misspelt as Chenye strokes. The other mistakes include the one on page 83, box 7.5, where 'examination' is mistakenly written as 'examinations,' and 'resistant' as 'resistance'; page 120, box 9.6, Alzheimer's as Alzeimer's; page 352, table 3].8, neuraxis as neuroaxis; page 313, it is written that “Table 27.6 shows the features in history and examination, which can help clinch the diagnosis”, this seems to be incorrect as Table 27.6 gives the classification of tics. In the chapter entitled “Approach to nonarterial ischemic strokes-central nervous system vasculitis”, the word “nonarterial” probably should have been “nonatherosclerotic”.figure 7
Most of the chapters in this book on differential diagnosis in neurology are based on various neurological symptoms and signs; however, there is a chapter on “craniovertebral junction anomalies-diagnosis and changing trends in management”. If this has been done because craniovertebral anomalies are common in India, then a chapter on viral encephalitides including Japanese encephalitis and leprosy should also have been included because they are equally common in our country.
The editors mention that this is not a one-time effort and promise to come back with a revised edition in future and hopefully these short-comings would be corrected in that edition. This book certainly fulfills the void that exists in the medical literature regarding a systematic approach to neurological differential diagnosis. Considering the simple and well-illustrated style of the book and its wide applicability and clinical relevance, I feel that this book will be useful for postgraduates in neurology.