Preface

We are very pleased to bring you the 11th edition of Adams and Victor’s Principles of Neurology. To provide the context for the continued importance and relevance of a textbook that aspires to such breadth and depth, it may be compelling to review a patient’s story; an event that took place between the last edition of this book and this one. Neurologists have always been particularly attracted to the case history as a method to imprint the fine points as well as the broad principles that can be gleaned in a clinical encounter. The originators of this book, Raymond D. Adams and Maurice Victor, insisted that the basis of the practice of neurology necessarily differs from that of neuroscience in that neurology is a medical discipline and must always be related back to the patient. Here is the story:

A 19-year-old college sophomore began to show paranoid traits. She became convinced that her roommate was listening in on her phone conversations and planning to alter her essays. She became reclusive and spent most of her time locked in her room. After much difficulty, her teachers convinced her to be seen by the student health service. It was believed she was beginning to show signs of schizophrenia and she was admitted to a psychiatric hospital, where she was started on antipsychotic medications. While in the hospital, she had a generalized seizure which prompted her transfer to our service. Her spinal fluid analysis showed 10 lymphocytes per mL³. She was found to have an anti-NMDA receptor antibody, which prompted an ultrasound examination of the pelvis. The left ovary was thought to show a benign cyst. Because of the neurological syndrome, the ovarian cyst was resected and revealed a microscopic ovarian teratoma. The neuropsychiatric syndrome resolved. She has since graduated and obtained an advanced degree.

This class of disease, autoimmune encephalitis, appeared briefly in the last edition of this book, and not at all in the previous one, but has become a major field of modern neurology, now expanded to include antibodies to many other antigens, occurring de novo or in association with an array of tumors. What of the patients whose stories approximate this one but do not have one or two essential components? One wonders how many other patients harbor curious autoimmune disorders, which will be uncovered in future editions of Principles of Neurology.

The clinical features of conditions such as cerebral amyloid angiopathy, posterior reversible encephalopathy syndrome, the neuromyelitis optica spectrum, and toxicity of treatments such as adaptive cell therapy have all been expanded. The novel treatments now being applied to cerebrovascular disease, multiple sclerosis, muscular dystrophy, amyloidosis, and inborn enzyme deficiencies are among a list of triumphs of science that can only be applied by careful clinicians. In the present edition there is hardly a category of disease that has not begun to yield to the molecular biology and genetics.

Outside the laboratory, clinical trials have continued to build the background of information that applies to large groups of patients with neurological disease. Clinicians are very aware, however, that the results of a trial have less certain meaning for an individual patient. It is the skillful use of this information that this book aims to inform. Will the single patient be helped or harmed? Because medicine deals with the realities and complexities of illness, the clinician makes a best approximation of the correct course. The wise application of science, evidence from trials, and the traditional virtues of the neurological history and examination—essentially the craft of neurology—are the main purpose of this edition of Principles of Neurology.

As has been our tradition, the book is written in a conversational style and we do not eschew stating our personal preferences when they are based on experience. We continue to find that readers value the uniformity of voice and approach of a few individual authors, rather than a discursive list of topics and writers. We thank Drs. Edward Stim, Mehrnaz Fallah, and Tim Lachman for invaluable assistance in proofreading the text.

For this edition we introduce as a coauthor Dr. Sashank Prasad, a seasoned general neurologist with special training in neuro-ophthalmology and a director of our neurology training program. We hope that reading the book will feel akin to attending our ward rounds, clinics, or morning report, thus giving the reader an intimate window into demands of practice, without being prescriptive. We hope this edition allows the physician to use the material as a basis for continued professional growth and enjoyment. Welcome to our world.