Neurology Book Report

Image result for clinical neurology localization-based berkowitz“What should I read?”

It’s a common question from students, especially future neurology residents, as well as advanced practice providers and allied health professionals set to care for neurological patients. It’s a hard question to answer because neurologists often rely on a variety of texts for different purposes. Reference texts such as Adams and Victor’s or Bradley and Daroff are too encyclopedic to recommend for straight-through reading unless the intended use is as a sleep aid (the latest edition of Bradley’s weighs in at 2348 pages). Brazis’s Localization in Clinical Neurology is indispensable for refining one’s localization skills, but isn’t suitable for a beginner’s approach to the field. Closer to the mark is Patten’s Neurological Differential Diagnosis. It’s quite readable, full of anecdotes, and suitable for the beginning neurologist. The drawings are marvelous. As big a fan as I am, this text is rather dated, not having been updated since 1996.

Clinical Neurology and Neuroanatomy, by Harvard neurologist Aaron L. Berkowitz, threads the needle perfectly. This isn’t surprising; Dr. Berkowitz’s CV shows over a half dozen teaching awards. He’s authored several other textbooks and  he directs the Global Neurology Program at Brigham and Women’s. I suppose nothing develops one’s neurological skills quite like practicing and teaching neurology in resource-limited areas.

Like many neurology texts, this one is divided in two parts, the first on the approach to patients with the different types of symptoms and the second on the neurological diseases themselves (epileptic, vascular, etc.) The first chapter includes a very important discussion of the neurological method (my own take on that is here), including a helpful and under-appreciated mention of localizing neurological disease to specific structures (e.g. Broca’s area on the left) vs. tissue types (peripheral myelin vs. axons) vs. systems (pyramidal, extra-pyramidal, etc.) I also like how well Dr. Berkowitz marries the neuroanatomical descriptions, say of the visual pathways, to the approach to to the patient with, in this example, visual loss.

I found much else to like in this text:

    • There are great explanations of tricky material such as strabismus, cover testing, and the use of the Maddox rod and optokinetic drum. There’s a good introduction to peripheral neurology and EMG. The chapter on neuromuscular junction disorders has an excellent description of low- and high-frequency repetitive nerve stimulation in myasthenia gravis and Lambert-Eaton myasthenic syndrome.
    • The fact that it was written by a single author is not only impressive, but also lends excellent consistency to the text, with emphasis on clinical pearls and the avoidance of minutiae. For example, the stroke chapter describes the role of the ABCD2 score, contains discussion of the difficult issue of when anticoagulation might occasionally be used in the acute setting, and describes the uncommon but important phenomenon of amyloid spells.
    • It’s very contemporary, including descriptions of relatively new entities such as encephalitis associated with anti-LGI1 antibodies and their association with faciobrachial dystonic seizures and the use of the HINTS exam in differentiating central from peripheral vestibulopathy. I was also pleased to see some references to the role of cognitive bias in diagnosis, such as a warning to avoid premature closure when attributing a patient’s delirium to “toxic-metabolic” causes.
    • The drawings are excellent, and there is much integration of modern neuroimaging into the anatomical and clinical discussions.
    • The tables are very clinically-oriented, rather than just listing long differential diagnoses as some texts do. For example, there’s a very good table comparing and contrasting the various Parkinsonian syndromes and another describing the early, late, and treatment-related complications of HIV.
    • There is judicious use of mnemonics. I’ve seen these get out of hand in some texts, especially board review books, but here they are relatively few but easy to remember. Example: The vein of Trolard is on top; Labbé is lower and more lateral.

I’m hard-pressed to identify a weakness here. Probably the most difficult chapter for the beginner will be the one on the upper extremity roots, plexus, and nerves; I think that’s just the nature of the beast. As I’ve mentioned before, there’s a great course on the brachial plexus available on the AAN website (registration required). There’s a very brief introduction to EMG and nerve conduction studies; it would be nice to see a similarly brief introduction to the technical aspects of EEG.

Simply put, this is a great introduction to clinical neuroanatomy and neurology and I recommend it highly.

Disclosure: The editors at McGraw Hill provided me a copy of the text for the purpose of this review, but I received no compensation for it and retain full editorial control.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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