Years ago, many neurologists took additional training in internal medicine beyond their medical internships (as they were called before we generically counted "postgraduate years") before beginning specialized training in neurology. Nowadays, this is a relatively uncommon practice. Yet, it is important that neurologists remember their roots in internal medicine and recognize the fact that we often encounter patients whose neurological problems are manifestations of other medical conditions.
In this issue of Continuum, Dr Martin Samuels, who has throughout his career maintained a keen interest in the interconnection between internal medicine and the specialty of neurology, chairs a talented faculty who remind us of the intimate link between neurological disease and other medical disorders. In the first chapter, Dr David Younger brings clarity to the often-perplexing group of diseases in the broad category of neurovasculitis. He provides both a thoughtful organization of the neurovasculitides and a cogent discussion of the clinical features, diagnosis, and treatment of the respective entities.
Among the most frequent in-patient consultations for neurologists are evaluations of postoperative cardiac surgery patients. Drawing considerably on their extensive experience at Johns Hopkins University, Drs Selnes, Grega, Borowicz, and McKhann provide a comprehensive discussion of the neurological aspects of cardiac surgery, focusing particularly on those problems associated with coronary artery bypass grafting. Dr Ronald Pfeiffer then provides a thorough and insightful look at the seemingly unlikely association between the bowel and the brain. More accurately stated, he reviews the neurological complications, both in the central and peripheral nervous systems, of a variety of gastrointestinal disorders, including hepatic disease.
Metabolic disorders, particularly those associated with electrolyte abnormalities, are another source of frequent consultation for neurologists. Drs Seifter and Samuels provide a straightforward, lucid, practical approach that will help neurologists understand and manage patients with these problems. Next, Dr Steven Feske, in his chapter on hyperperfusion syndromes, finds the common denominator in a group of seemingly heterogeneous disorders that includes hypertensive encephalopathy, postcarotid endarterectomy syndromes, eclampsia, and the cerebral edema associated with the use of cyclosporine A. Finally, Dr Paul Ridker and Dr Samuels provide a discussion of the hot topic of inflammation and neurological disease. This chapter is further evidence that not only offers thorough topical reviews of neurological subjects, but also keeps you up-to-date on the latest information clinically relevant to neurological disease, better enabling you to meet your goal of life-long learning in neurology. Indeed, just as I prepared to write this preface, Dr Ridker's latest publication in the New England Journal of Medicine on the association between levels of C-reactive protein and myocardial infarction made front page news in the New York Times.
As neurologists, we are rightly proud of the advances that have been made in the understanding and treatment of neurological diseases. We are steadily moving away from the situation with many disorders that one of my mentors, the late Dr Labe Scheinberg, described (in speaking specifically of multiple sclerosis) as "diagnose and adios." It, nonetheless, behooves us to remember our enduring genealogy in internal medicine and the fact that the integrity and normal functioning of both the central and peripheral nervous systems require the health of many other organs. We are indebted to Dr Samuels and his knowledgeable faculty for updating our knowledge and strengthening our bond to internal medicine.
Aaron E. Miller, MD