Signature Clinical Signs in Neurology – Book Review

Author: Rahul T Chakor, Swaleha Nadaf Year: November 2024 Publisher: Clever Pen Publishing ISBN: 978-93-92215-78-0 Rahul T Chakor, Swaleha Nadaf (Editor): Signature clinical signs in Neurology 2024: Clever Pen Publishing ISBN 978-93-92215-78-0. Paperback, Price: 1750. 509 pages Clinical skills are the tenet of neurosciences. “Signature Clinical Signs in Neurology,” written by Prof. Rahul T. Chakor and Assistant Prof. Swaleha Nadaf, is a carefully designed and engaging book that fully explores the art of eliciting bedside clinical signs. The chapters are organized alphabetically, with each beginning with a brief description of the sign, followed by methods to elicit it and embedded video links demonstrating the procedures. The book’s opening chapter on alexia and agraphia sets the tone with an introduction followed by localization and the differentiation between central and peripheral alexia. Neuro-ophthalmology and vestibular disorders often weaken even the most experienced resident doctors. The authors, recognizing this, have effectively simplified the concepts and made the material engaging for the reader. The section on supranuclear eye movements, including ocular tilt and ocular skew, offers comprehensive explanations on how to differentiate skew from the frequently confused fourth nerve palsy. The chapter on chiasmal field defects covers more than just inflammatory conditions causing chiasmal involvement; it also briefly mentions craniopharyngioma, Rathke’s cleft cyst, and sphenoid wing meningioma as other differential diagnoses. These clinical insights will benefit both neurology and neurosurgery trainees. The quick-reference sidebar in each chapter will be particularly helpful to students during last-minute exam preparations. The chapters on “hand signs in neurology” highlight the thoroughness and many years of clinical experience of the authors. The hand signs in pyramidal, extrapyramidal, and lower motor neuron disorders have been described in a novel way. Interestingly, the ictal hand posturing for symptomatogenic zone localization in epilepsy has also been covered. Seamlessly, electroencephalogram and electromyogram findings have been integrated into the chapters on post-hypoxic myoclonus and fasciculations. This comprehensive, efficient approach makes the book invaluable. The “Pen and Paper Tests” chapter is uniquely conceptualized and well-curated, distinguishing between rest and kinetic tremors. The importance of remembering our past is illustrated by a brief history and photographs of the pioneers whose fundamental work advanced our understanding of Parkinson’s disease in the chapter on rigidity, lead-pipe, and cogwheel symptoms. The authors also included a chapter on the Kayser-Fleischer ring in Wilson’s disease. In 1911, Dr. Samuel Alexander Kinnier Wilson first described this disease in his research thesis for his Doctor of Medicine degree at the University of Edinburgh. He received a gold medal for his insightful bedside observations and was awarded the degree. His observations of tremors and rigidity in siblings led him to conclude it was a familial disease, long before the era of genetics. Simply put, a dedicated heart and a keen eye are all that are needed to understand and appreciate neuroscience. While the Brown-Sequard syndrome chapter introduces myelopathy, a more detailed account of spinal cord syndromes and signs, such as dissociative sensory loss, onion-peel pattern of sensory loss, false localizing signs in myelopathy, and others, would improve the comprehensiveness. The pen-touching test for abductor pollicis brevis will be a welcome addition to the lower motor neuron “Hand signs in Neurology” chapter. Examination of an unconscious patient, elaborating the signs of cerebral herniation and other eye signs like the “roving eye” in metabolic-encephalopathy, will engage students and faculty from neurology and neurosurgery alike. These topics can be explored in future editions. In today’s era, advances in neuroimaging, intervention, robotics, and artificial intelligence have produced results beyond what was imagined two decades ago. Technology should serve us and enhance the art of clinical neurology. The skill and acuity of bedside clinical diagnosis have become rare nowadays. Nevertheless, accurately localizing a condition without neuroimaging still impresses young, impressionable minds. This knowledge must be passed on to the next generation of neurologists and neurosurgeons. This book leaves no stone unturned in this regard. It is here to stay and will undoubtedly be one of the most referenced books in clinical bedside neurology.