Standard textbooks of neurology commonly include an introductory chapter on the clinical examination but otherwise provide little guidance as to how this is best performed. The exception is De Jong’s The Neurologic Examination, first published in 1950, which was intended to present in detail the information necessary to perform a complete and clinically useful examination, accompanied by limited descriptions of the findings in common neurologic entities or disorders. If anything, the need for such an account has increased with the passing years. The art of the neurologic examination is being lost as clinical medicine becomes depersonalized and as new diagnostic and monitoring techniques are used in its place. Moreover, little time is left to learn the intricacies of the physical examination in today’s crowded medical school curriculum. The publication of this new (eighth) edition of De Jong’s classic text, authored by William Campbell and Richard Barohn, is therefore timely and to be welcomed. It is a pleasure to introduce the book and its authors to another generation of readers.
Dr. Campbell is professor emeritus and former chair of the neurology department at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. I have known him since he was a resident in San Francisco more than 40 years ago. He has had an illustrious career and is well known for his clinical skills and diagnostic acumen. He has authored a number of clinical studies on different aspects of neuromuscular disorders and received the Distinguished Physician Award of the American Association of Neuromuscular and Electrodiagnostic Medicine in 2011. Almost 20 years ago, he took over DeJong’s book—the fortunes of which had declined as technologic advances came to influence the practice of neurology—and single-handedly rewrote and revived it. The sixth edition, the first that he authored, was published in 2005 and soon restored the reputation of the book, earning for it a well-deserved place on the bookshelf of many neurologists. He remained the sole author for the seventh edition, published in 2012, but now has been joined by Richard Barohn in preparing this eighth edition.
Dr. Barohn, professor and former chair of the department of neurology at University of Kansas Medical Center, is another accomplished neuromuscular clinician and investigator. In 2013, he received the Distinguished Researcher Award of the American Association of Neuromuscular and Electrodiagnostic Medicine and was named a University Distinguished Professor at the University of Kansas for his achievements.
The book that Campbell and Barohn have authored serves an important need as a guide to both trainees and established physicians. The neurologic examination can be lengthy, often requires much attention to detail, is sometimes performed in difficult or unpleasant circumstances, and may be overwhelming to trainees. Its importance, however, cannot be overemphasized. The findings obtained thereby help to confirm a suspected diagnosis, determine whether any further investigations are needed, indicate the clinical relevance of any laboratory or imaging abnormalities, and suggest the extent and prognosis of many disorders. The competently performed examination also helps to establish a bond between patient and physician that is essential to the welfare of the former and professionally satisfying to the latter.
The neurologic findings become especially meaningful as their relationship to changes in the structure and function of the nervous system comes to be understood. One of the goals of the present volume is to emphasize such a relationship, and the authors have achieved this aim admirably. The text in this new edition has been shortened slightly by reducing discussions of various disease entities to focus on the clinical findings and their significance. Numerous illustrations—most in color—increase the breadth of the book. Several of the older figures from earlier editions have been replaced, and new figures have been added. A number of videos are embedded in the text, with links to many more, as well as to Dr. Campbell’s instructive neurosigns.org Web site. In consequence, readers of this book will be able to learn more easily the intricacies of the examination and what to seek when examining patients with different neurologic disorders. They will come to understand the nature and importance of different neurologic signs and will be able to learn from expert clinicians how best to elicit them. Earlier editions have previously received wide recognition and are deservedly familiar to many clinicians. This new edition, which is both scholarly and practical, is even better. It is a mine of information and will be an important resource for many years to come.
Perhaps remarkably in this 21st century but following in the tradition of its predecessors, this new edition is written in its entirety by these two eminent physicians and thus has a uniformity of style that is pleasing. The various chapters fit seamlessly together to produce an integrated and well-rounded account that is based on the accumulated experience and wisdom of its authors. I believe that the book will become an indispensable resource for trainees and practitioners involved in the care of patients with neurologic disorders. I am delighted at its publication, am privileged to introduce it to its intended readership, and congratulate Dr. Campbell and Dr. Barohn for producing such an outstanding volume.
Michael J. Aminoff, MD, DSc, FRCP
Distinguished Professor of Neurology
University of California, San Francisco