Adams and Victor's Principles of Neurology

 
Elio Lugaresi
Italy
 
Bihm Singhal
India
 
Jaime Toro
Columbia

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ix
Preface
Neurology is the broad field of clinical study of the ner-
vous system. As a profession, it is a highly enjoyable
endeavor that is a constant source of professional and per-
sonal enrichment. Through 
 
Principles of Neurology
we
have the privilege of continuing a tradition established 35
years ago by our esteemed teachers Dr. Raymond D.
Adams and Dr. Maurice Victor. Our friend and colleague,
Dr. Robert Brown, ably participated in the eighth edition,
adding his expertise in the neurosciences, much to our
benefit and that of the book. 
 
Principles of Neurology
 
 
originated from the chapters on
neurological diseases in the first several editions of 
 
Harrison’s
Principles of Internal Medicine
. The continued expansion of
these sections by Adams and Victor, despite repeated com-
mitments to shortening them, led an exasperated Tinsley
Harrison to exclaim to Dr. Adams “…. we’ll have to change
the name of the book to Principles of Internal Medicine and
Details of Neurology.” Ray Adams wrote the entire first edi-
tion of the book in longhand during his summer vacation of
1975 in Lausanne and asked his highly regarded young col-
league Maurice Victor to round out the manuscript over the
following year. Adams and Victor attracted considerable
attention by initiating a new style of pedagogy that empha-
sized the basic principles of neurology before introducing the
disease entities. 
While the enormous advances in imaging, genetics,
molecular biology, and pharmacology have improved our
capacity to diagnose and treat disorders of the nervous
system, they have not reduced the necessity to understand
certain basic principles of anatomy and physiology, to
obtain the correct history, perform a capable neurological
examination and to cohere them based on a body of clini-
cal knowledge and experience. We continue the original
structure of the book, re-affirming that comprehensive
knowledge of clinical neurology is required to meet the
challenge of this sophisticated specialty. We have also
maintained personal authorship with the hope that a sin-
gle voice will allow the reader to enjoy the experience of
learning the field from two longtime practitioners in a
manner similar to the way we learned it from the original
authors and their colleagues.
In taking the responsibility of revising this book, we
acknowledge that pedagogy in medicine has changed
enormously to accommodate technical advances, particu-
larly those in imaging. However, certain principles seem
immutable and they derive from the traditional principles,
virtues, and logic of medicine that dominate neurological
thinking. Clinical neurology, being an applied science,
depends on a set of heuristics that direct the clinician to
the best diagnosis and therapeutic plan. This book pro-
vides an exposition of clinical material in an order that
should allow the reader to obtain a comprehensive view
of the field and at the same time appreciate the full
breadth and depth of each disease of the nervous tissue.
At the same time we have written the chapters on major
diseases in a manner that allows the book to be used as a
reference in depth. 
Certainly, advances in neuroscience inform one’s per-
spective on the nature of disease and produce a fuller ap-
preciation of the manifestations in each patient. A case in
point is the large number of previously inexplicable de-
generative diseases that have yielded to scientific under-
standing on the levels of pathology, genetics, subcellular
mechanisms, and neurochemistry. At the same time, thera-
peutic advances often precede basic understanding of dis-
ease and the neurologist has the duty to provide the best
possible treatment at the time, even if science has not pro-
vided a full explanation or mechanism. Examples abound;
we have an incomplete understanding of epilepsy, Parkin-
son disease and multiple sclerosis but many reasonably ef-
fective treatments have been devised. While the
neurosciences are the instruments of advance in under-
standing disease, the work of clinical neurology is more
pragmatic, yet it retains its own form of scholarship. Neu-
rology is not simply a trade in relation to the sciences. Dif-
ficulty in mastering neurology derives from a need to
combine considerable knowledge and personal experience
with special skills of observation and disciplined thinking.
Our goal is to present an assemblage of clinical knowl-
edge, and we hope wisdom, rather than disembodied
facts. The book contains information that should be the
property of the well-educated physician at all levels, in-
cluding the medical student, resident, practitioner and ac-
ademic physician. The neurologist stands at the nexus of
the study of the nervous system and includes many as-
pects of general medicine, psychiatry, neurosurgery, pain
management, rehabilitation, ophthalmology, otolaryngol-
ogy, anesthesiology, critical care and emergency medicine
and Neurology serves as Medicine’s spokesperson to soci-
ety on matters such as mental capability, learning and
teaching, aging and the brain, death, and disability. There-
fore the breadth of Neurology has directed the liberal in-
clusion of material in the book. 
Neurology, like internal medicine, has become increas-
ingly subspecialized. Modern departments of neurology
include divisions of stroke, epilepsy, movement disorders,
sleep, neuromuscular disease, multiple sclerosis, pain and
headache, otoneurology, neuro-ophthalmology, cognitive
and behavioral neurology, critical care neurology, spinal
disorders, neuro-infectious diseases, cancer neurology, and
pediatric neurology. Yet, there is a need for all clinicians,
including the subspecialist, to maintain a comprehensive
understanding of the major categories of neurological dis-
eases. We respect and commend the community practi-
tioner who by necessity maintains a broad gauge view of
the field and we write with them in mind.
We thank our many colleagues who reviewed chapters
and suggested alterations or additions. Several readers

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