Handbook of clinical neurology
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Historical Article
Chapter 12: the anatomical foundations of clinical neurology.
The chapter provides an itinerary of knowledge on nervous system anatomy as one of the pillars of clinical neurology. The journey starts from the Renaissance explosion on the approach to the human body, its functions and its diseases, dealing with the seminal contributions of Leonardo da Vinci and Vesalius. ⋯ The chapter also includes sections on the contributions of developmental neuroanatomy to neurology, on the history of tract tracing, and on the cytoarchitecture of the cerebral cortex. The never-ending story of the anatomical foundations of clinical neurology continues to evolve at the dawn of the 21st century, including knowledge that guides deep brain stimulation, and novel approaches to the anatomy of the living brain based on rapidly developing neuroimaging technology.
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Insight into the molecular mechanisms involved in primary headaches is important to identify drug targets for improving treatment of patients, but essentially lacking. Genetic research is increasingly successful in pinpointing these mechanisms. Most progress has been made for Familial Hemiplegic Migraine, a rare subtype of migraine with aura. ⋯ Except for the MTHFR gene no gene variant has been identified yet. Convincingly demonstrated genetic findings in other primary headaches such as cluster headache and tension-type headache are even rarer. However, with current technical possibilities of massive genotyping and international efforts to collect large well-phenotyped patient cohorts, the first gene variants for various primary headache types are likely to be discovered in the coming decade.
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Historical Article
Chapter 8: the development of neurology and the neurological sciences in the 17th century.
Circa 1660 several favorable factors, instrumental to the invention of neurology, converged at the University of Oxford. Animals and men were believed to have a material soul whose functions throughout the nervous system were accessible to research. In 1659 inductive methods were introduced in clinical medicine by Thomas Willis, the founder of English epidemiology and biochemistry. ⋯ There was a physiological part, a textbook of neurophysiology, and a pathological part, a compendium of neurological and psychiatric syndromes, with early descriptions of myasthenia, restless legs, narcolepsy, dissociative and bipolar disease, and general paralysis of the insane. In 1667 he published a book on convulsive diseases, in which he described the blood-brain barrier, epileptic and hysterical brain disorders, and Parkinson's disease. Thus Willis recognized and presented the key themes of the future specialty.
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Bacterial meningitis is a neurological emergency. Empiric antimicrobial and adjunctive therapy should be initiated as soon as a single set of blood cultures has been obtained. ⋯ Patients with documented bacterial meningitis and those in whom the diagnosis is a strong possibility should be admitted to the intensive care unit. Timely recognition of bacterial meningitis and initiation of therapy are critical to outcome.