Download How to Think Like a Neurologist: A Case-Based Guide to Clinical Reasoning in Neurology 2022 Easily In PDF Format For Free
“Meltzer’s How to Think Like a Neurologist is even more than that—it’s a mas
terful clinical handbook for learning how to tackle unknowns. What do you
do if the diagnosis is not already obvious and there is no algorithm to follow?
How do you tailor your history by asking probing questions that will help to
refine hypotheses? And how do you refute your hypotheses through directed,
customized neurological examinations? The syndromic approach beautifully
elaborated by Meltzer is a prerequisite for delivering the kind of value-based
and patient-centered care we all seek—and to do so one patient at a time.”
“How to Think Like a Neurologist presents a clear, practical approach to
clinical reasoning in neurology. Working step by step through a series of
real-world cases, Dr. Meltzer uses a conversational style to elucidate the
principles of neurologic diagnosis. This is essential reading for students on
their neurology rotation, residents in neurology, and any medical provider
seeking to improve their understanding of clinical neurology.”
“Finally, a book that captures the intangibles of neurologic diagnosis.
The synthetic ability that combines knowledge of how diseases affect the
nervous system, personal clinical experience, and systematic inquiry is on
display. Nowhere do these qualities come together more obviously than in
neurology. By analyzing clinical cases that delve into the inner workings of
a master clinician, Meltzer has provided a terrific contribution to pedagogy
and to clinical work in the field.”
Pace is the onset or evolution of a patient’s symptoms. You likely
already incorporate many questions into your history of present ill-
ness with the intent to define the pace. When did the symptoms
start? How long did the symptoms last? How have the symptoms
changed since onset? Critically important in neurology, we define
pace based on the initial onset and evolution of symptoms, rather
than the total duration of symptoms. For example, a patient may
have a fixed deficit from a stroke suffered years prior, but the pace
would still be defined as quite rapid (hyperacute) if their symptoms
initially developed over seconds to minutes. This principle holds
true for all categories of pace.
Subacute symptoms develop over days to weeks to months. The
boundary between the patient’s baseline and the onset of symptoms
starts to blur, and the patient may not be aware of when their
symptoms started. However, they might remember a specific event
when their symptoms first became noticeable. For example, a pa-
tient might report, “I was an avid runner, but a month ago I started
noticing that it was taking me longer to do my usual route. About
a week later, I tripped over a small step on the sidewalk. Since that
time, I have stumbled over my left foot a few times, and my hus-
band says that he can hear my foot dragging across our floor when I
walk.” Distinguishing between a subacute versus a chronic onset of
symptoms might be challenging for a patient or their family (as well
as the clinician) to define, since the boundary between normal and
abnormal may not be clearly demarcated. Questions that attempt
to draw a frame around the timeline can be helpful: “Were your
symptoms present 2 months ago when you took a trip with your
family?” or “When was the last time that your mother was able to
handle her bills on her own?”
Chronic
Lastly, chronic symptoms develop over months to years. The
boundary between the patient’s baseline and the onset of symptoms
might not exist. There is no official start time, but typically, a patient
