KNV's Manual of Clinical Neurology
KNV's Manual of Clinical Neurology
K Neelakantan Viswanathan
MBBS (JIPMER) DNB (Med) FRCP (London) FRCP (Glasgow) FACTM AB (US) FACP (US) FCCP FIACM Senior Professor of Medicine Sri Manakula Vinayagar Medical College and Hospital Puducherry, India
Forewords
KR Sethuraman
Ashok Kumar Das
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KNV's Manual of Clinical Neurology / K Neelakantan Viswanathan
First Edition: 2023
9789354659317
Printed at:
Dr KR Sethuraman MD PGDHE FICA
Senior Professor and Dean – Faculty of Medicine, AIMST University
Malaysia
Former Vice-Chancellor
Sri Balaji Vidyapeeth Deemed University
Puducherry, India
As a former collegemate and a senior of Dr K Neelakantan Viswanathan (KNV as he is known), I feel privileged to write this foreword for the manual on clinical neurology titled “KNV's Manual of Clinical Neurology.”
Clinical neurology is a fascinating clinical science and an art that is based on effective communication, astute observation, mindfulness, and an ability to relate a patient's symptoms and signs to neuroanatomy and neurophysiology. Since the human brain and the nervous system are quite complex, learners often use various mnemonics to help them remember a myriad of facts and figures. KNV has cleverly incorporated this strategy in this manual.
Dr KNV has been a serious academic scholar throughout his long career. He is passionate about clinical bedside teaching and takes pains to impart effective clinical skills to his students. A strong foundation in clinical neurology might make future medical professionals more confident of their bedside diagnostic skills and less likely to adopt a “shot-gun approach” to diagnosis by ordering all and sundry investigations.
I am sure the carefully crafted manual will find ready acceptance among the undergraduate and postgraduate medical students.
Dr KR Sethuraman
Foreword
Dr Ashok Kumar Das MD PhD FAMS FRCP FICP FACP
Consultant Physician and Endocrinologist
Former Professor Medicine and Endocrinology, JIPMER and PIMS
Former Dean and MS, JIPMER
Patron RSSDI, Co-Chair–ICMR-INDIAB Study
Chair-ICMR Diabetes in the Young Registry
Member of Academic Committee of National Academy of Medical Sciences
New Delhi, India
Former National President, RSSDI and API
Former Dean of Indian College of Physicians
This is an excellent manual centered around clinical neurology which is one of the most important contemporary and challenging subjects in medical sciences. This book is aimed at postgraduate students in medicine and will also be extremely useful for undergraduates and has a great utility for those wishing to specialize in neurosciences. The primary target of this manual is to impart training in clinical neurology to the undergraduates and postgraduate students in medicine and neurology. Needless to mention, this manual fulfills a great unmet requirement.
The chapters are organized around important illnesses in neurology encountered in day-to-day practice and those clinical cases that feature in examinations. State-of-the-art illustrations and easy readability with mnemonics are the great assets of this book.
I must mention that the author, Dr K Neelakantan Viswanathan, who worked under me in the prestigious institute of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in his undergraduate days, has been one of the most acclaimed and much sought after Professors of Medicine with a special interest and focus on neurology. He possesses many academic credentials in medicine. He has also worked for nearly 3 years at National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, and also had a small academic stint abroad. The author has been a teacher of teachers for several years in India and overseas. His unique experience of being an examiner for about 150 undergraduate and postgraduate examinations has been translated into this book. He knows the pulse of the students and what they exactly need to know for the examinations. He is an adept teacher and this manual is a great instrument in enhancing the student's clinical and practical knowledge of Neurology and facing their examinations.
Beyond this, the book is a great gift for consultant physicians and even budding neurologists. The unmet need of a manual with easy to remember mnemonics and fun-filled learning has been fulfilled by Dr Viswanathan. I have great pleasure in recommending this book to the undergraduates who find Neurology difficult and for the postgraduates in medicine because it happens to be their good companion for examination and managing neurological cases in their day-to-day practice besides facing the examiners in their “long cases.”
Neurology is one of the most important contemporary challenges of the current time which is the “decade of the brain.” It is apt that this manual has been brought out now to fill the void in history taking and clinical examination when the multitudes of recent investigations with several technological advances are of vogue and have relegated clinical neurology to the background.
I recommend this book to all students with great enthusiasm.
Dr Ashok Kumar Das
Message from the Director
Dr D Rajagovindan
Director, Sri Manakula Vinayagar Medical College Hospital
Puducherry, India
I have had the opportunity of being associated with Dr K Neelakantan Viswanathan for the past 34 years and during this period, he has always surprised me with his sheer dedication and commitment to teaching and learning. He has an enviable ability to teach clinical medicine and clinical neurology.
Not only the ability, he is blessed with the right kind of attitude to serve the society with his tireless, brilliant knowledge and skills. I feel privileged to write an introduction for a book authored by such a person of high scholar and knowledge. As his thirst for knowledge is unquenchable, his popularity among medical students is unparalleled.
He is not only a nationally respected teacher but also a renowned physician. The book “KNV's Manual of Clinical Neurology” is one of the needs of the hour, when students are struggling with numerous names to learn by heart and reproduce them meaning fully in relevant contexts. By introducing mnemonics in this book, Dr Viswanathan has not only made the jobs of the students easier but also he has made it a cake walk for the examination goers. Also, no doubt, he has earned the acclaims of his fellow teachers and doctors.
He has fellowships from the American College of Physicians and Royal College of Physicians, London and Glasgow. He is in the international advisory board member for Kumar and Clark's Clinical Medicine and Davidson's Principles and Practice of Medicine.
Dr Viswanathan has had his undergraduate degree from JIPMER, postgraduate degree from MMC/National board. He had his training in neurology at NIMHANS for nearly 3 years. As of now, he has got 37 years of teaching experience. He worked in Sri Ramachandra Medical College for 15 years. Now he is working in Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India for 6 years. He has got 50 publications to his credit and he has authored 17 international and three national book chapters. He has been an examiner for several MD/DNB/MBBS examinations for many Indian universities.
I am sure this “Manual on Clinical Neurology” is going to benefit thousands of students and teachers as well. The principles, concepts given in the manual are basic, concise, easy to understand, and very much student-friendly. If you are preparing to take an examination in medicine, then this is “the book” you should read.
I congratulate Dr Viswanathan for this tremendous work and wish him all the best.
Dr D Rajagovindan
Preface
K Neelakantan Viswanathan MBBS (JIPMER) DNB (Med) FRCP (London) FRCP (Glasgow) FACTM AB (US) FACP (US) FCCP FIACM
Senior Professor of Medicine
Sri Manakula Vinayagar Medical College and Hospital
Puducherry, India
Preface is the least read section of a book or sometimes not read at all by many, it being pooh-poohed as codswallop. Contrarily, the preface explicates the illustriousness of the book and tells the readers why it is brought out and what it is meant to convey.
Neurology has always been a nightmare for undergraduates and postgraduates alike, the subject being relegated to the background by a majority. Patients with neurologic ailments not only present commonly to the general physician but also happen to be “long cases” in university examinations. This is due to the fact that interactive discussions in arriving at a logical diagnosis from a punctiliously taken history and a well-conducted clinical examination are almost possible presently with exactitude with the help of basic investigations. The adage of the importance of listening to the patient who is telling you the diagnosis from history is the bottom-line truth even in the present era of a multitude of advanced technological investigations. Concepts in neurology should be made easy to understand so that the students can retain them and reproduce the same with certitude in the examinations and that is the main reason for bringing out this manual, although several standard textbooks on the subject are available. This manual caters mainly to the needs of postgraduates but undergraduates and students of allied neurosciences may also find selective chapters useful.
A postgraduate in medicine should ideally read standard textbooks of medicine, journals, and supplement them with notes from reference and specialty textbooks. This Manual of Neurology was brought out to help the students understand the concepts of the subject better and revise the subject during the examinations with the help of “mnemonics”. But compromising the contents at the expense of aide memoire is otiose. The manual is meant as a supplement and not a substitute to the standard texts. This manual also substantiates the fact that clinical neurology is paramount and exemplary and minor abnormalities that occur in the extensive investigations do not fully explain the patient's illness and at times tend to mislead the physicians.
I reiterate the verisimilitude that uncommon manifestations of common disorders are more common than common manifestations of uncommon disorders (e.g., cerebellar ataxia which is an uncommon manifestation of hypothyroidism is more common than cerebellar ataxia due to ataxia telangiectasia, which is rare). Hence, one should always think of and investigate common disorders that are reversible. Certain recherché syndromes mentioned in the manual are only for the sake of completion and fall under the “nice to know” and not “must know” category.
Any student of medicine should wallow in the knowledge of medicine by “enjoying” his learning and working in the wards and not consider them as baptism of fire. There is no substitute for examining a patient in the wards and working him up in detail.
All spellings used in this manual are in American English for ease and convenience.
I wish all students “happy reading and revising!”
K Neelakantan Viswanathan
Acknowledgments
‘Gratias tibi’
I initially thank the Almighty for giving me the mental and physical strength to bring out this manual.
My thanks start from my beloved school teachers who strived to inculcate self-discipline in me besides teaching me the basic values of life. Next I thank the zealous and dedicated teachers in JIPMER especially Professor S Chandrasekhar, Professor K Sankaran, Professor DS Singh (late) and their team in medicine who molded me into a physician and the stalwarts in neurology, then at NIMHANS, like Professor M Gourie Devi and Professor HV Srinivas, who instilled the fact into me that clinical neurology is paramount in arriving at a diagnosis. I owe my allegiance to them for coaching me intensively in clinical neurology during my resident days which made me think the world of them and also “groove on” the subject.
I will be failing in my duty if I do not extend my thanks to the doyens of Medicine in Madras Medical College, especially Professor C Senthilnathan (late), Professor VT Balaraman (late), under whom I worked to acquire my postgraduate degree in medicine and Professor N Karunanithi along with Professor Krishnamoorthy Srinivas (late), whose neurology lectures were an afflatus to me.
I profusely thank Sri NPV Ramasamy Udayar (late), industrialist, philanthropist, educationalist, and the founder Chancellor of Sri Ramachandra University who set the platform for me to lucubrate and expound my knowledge in teaching the undergraduates and postgraduates of SRMC and RI.
I extend my thanks to all faculties in the medicine department in SRMC and RI, Chennai, with whom I had a pleasant stay during my tenure there.
I wish to convey my sincere thanks to Dr Ashok Kumar Das and Dr KR Sethuraman for their forewords.
At this juncture, I wish to acknowledge the following persons who helped me in the preparation of the manual:
- Professor AK Badrinath, Professor C Manokaran, Dr J Sathiyanarayanan, Dr Karthik J, Dr Manomenane PG, Dr Araveinth PG, Dr Jeffrey Ambrose PG, Dr S Moorthy PG, Dr Varsha Reddy PG, Dr Kawiraj PG, Department of Medicine, SMVMCH, Puducherry and Dr E Priscilla Rubavathy, SR in Medicine, PIMS, Puducherry, for their illustrations
- Professor S Girija, HOD of Medicine, Professor MK Uthaya Sankar, Associate Professor G Premkumar, Dr Kailash along with the other Assistant Professors, SRs and PGs in Medicine for their constant encouragement and moral support
- Dr Sham Santhanam, Consultant Rheumatologist, Kauvery Hospital, Chennai, for his chapter on Neurologic Manifestations in Rheumatic Diseases.
- Dr VL Arulselvan, Consultant Neurologist, Apollo Hospitals, Chennai, for his chapter on Dementias
- Dr J Karthik, SR in medicine, SMVMCH, for his chapter on Neurosyphilis-recent Trends
- Professor A Arul Kumaran, Department of Pediatrics, SMVMCH, Puducherry, for the illustrations
- Professor Nallamuthu, Department of Ophthalmology, SMVMCH, Puducherry, for the ophthalmic illustrations and fundus photographs
- Assistant Professor Elamparidhi and Dr Bharathi PG, Department of Radiology, SMVMCH, Puducherry, for the radio images
- Dr M Balachandran, Consultant Neurologist, SMVMCH, Puducherry, for the illustrations
- Professor S Anandan, Dean of Faculties and Professor of Dermatology, SRIHER, Chennai for the illustration
- Dr Mohamed Iliyas, Assistant Professor of Cardiology, SCTIMST, Trivandrum for his illustrations
- Dr Mohammed Anas PP, Dermatologist, Perinthalmanna and Dr P Nandhini, Dermatologist, Erode for their illustrations
- Dr Sathyan Parthasarathi, Consultant Ophthalmologist, Coimbatore, for the chapter on atlas of fundus photographs
- Dr Sairaman H, Assistant Professor, Department of Medicine, Madurai Medical College, Madurai, for his illustrations from Government Rajaji Hospital, Madurai
- Dr S Thenmozhi Karthikeyan, PG in Medicine, SMVMCH, for improvising some clinical photographs
- Mr R Murugan, Artist, Department of Community Medicine, SMVMCH, Puducherry
- Mr G Sivaperumal, Photojournalist, Chennai
- Mr Nana NS, Art Director, India Today, Chennai
I also thank the Chairman and Managing trustee Mr M Dhanasekharan, Vice Chairman Mr SV Sugumaran, and Secretary Dr Narayanasamy Kesavan for their valuable support and the Administration especially Director Professor D Rajagovindan for his kind introductory message, Deputy Director and Dean Professor RN Kagne, Dean (Academic) Professor K Karthikeyan, Dean (Research) Professor G Kalaiselvan, Medical Superintendent Professor M Pragash, and other administrators for their relentless encouragement lent to me in bringing out this manual.
I thank all patients for their support without whom my task would have not been possible.
I also thank the entire team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, especially Shri Jitender P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Dr Rajul Jain, Dr Richa Saxena (Associate Director-Professional Publishing), Ms Upasana Kak (Development Editor) and Ms Ritu Kumari (Development Editor) for bringing out this manual in a short time.
Finally I thank to the nth degree all my family members who lent me their support wholeheartedly all through my work on this manual.
K Neelakantan Viswanathan