Students of neurobiology, especially medical students, often experience a wheat-chaff problem: Amidst an onrushing deluge of facts and concepts, how does one tell which information has clinical relevance? Do physicians actually encounter symptoms and signs that reflect the difference between ligand-gated and voltage-gated ion channels? Does the proper choice of diagnostic studies ever require awareness that the spinothalamic tract is a crossed ascending system whereas the dorsal column is not? Does it matter that a protein called tau binds to microtubules? It was with such questions in mind that Dr. Eric Kandel invited me to write a companion volume to Kandel, Schwartz, and Jessell’s Principles of Neural Science, Fourth Edition, with the broad aim of demonstrating the applicability of neurobiology to clinical decision making. In addition, it was thought readers might discover that understanding clinical phenomena in neurobiological terms can be good fun.
Practice of Neural Science: A Case-Based Approach is an extensively updated version of that book, now serving as a companion volume to Principles of Neural Science, Sixth Edition. As before, the book is designed especially for students and residents, but seasoned clinicians and investigators are welcome. Part I includes a mostly neuroanatomical description of the neurological examination. Part II consists of 79 clinical vignettes, which are discussed neuroanatomically, neurophysiologically, and, in some cases, neurogenetically. Each case makes an appearance somewhere within the Neurological Examination section, so that the reader can relate that part of the examination to a real-world situation. Conversely, the cases are arranged systematically (eg, somatosensory, visual, auditory, olfactory, motor, or autonomic impairment; disorders of consciousness, language, cognition, or behavior), allowing a reader who wishes to start with the vignettes to refer back to the appropriate section of the Neurological Examination.
Medical students in neurobiology courses can use this book for previews of coming attractions; they will, I hope, be reassured that much of what they are slogging through really matters. Neurology clinical clerks or residents can use the book to refresh their memories—or, perhaps, in some instances, to update their fund of information. Undergraduates and graduate students studying neurobiology can use the book to gain insight into how an understanding of the nervous system is the foundation of clinical neurology, neurosurgery, and psychiatry.
This is not a comprehensive textbook. Cases have been selected to cover a broad array of neurological and neurobiological phenomena, but they are, after all, only 79 in number. Some involve patients I have known over the years. Others are from case reports in the literature.
Thanks are in order. Eric Kandel, Steven Siegelbaum, Lewis P. Rowland, Timothy A. Pedley, and Robert E. Lovelace nipped a number of gaffes in the bud. Much of the artwork, from successive editions of Principles of Neural Science, was the responsibility of the late Sarah Mack. Michael Weitz and Kim Davis of McGraw Hill were proactive, patient, and a pleasure to work with.
Finally, to return to the original questions posed above, the answers can be found in Part II, Cases 19, 45, and 77.