Very few organ systems, if any, present as fascinating an array of structures and mechanisms as the human brain and spinal cord. Furthermore, it is hard to think of a clinical field that does not encompass at least some aspect of the neurosciences, from molecular and cellular neurobiology through motor, sensory, and cognitive neuroscience, to human behavior and even social interactions. It is the brain, in fact, that makes us uniquely human. No surprise, then, that neuroscience has emerged as one of the most exciting fields of research and now occupies a central role as a substrate for clinical medicine.
One of the unique things about the nervous system is its exquisite architecture. The nervous system contains more cell types than any other organ or organ system, and its constituent nerve cells—more than 100,000,000,000 of them—and an even larger number of supportive glial cells are arranged in a complex but orderly, and functionally crucial, way. Many disease processes affect, in a direct or indirect way, the nervous system. Thus, every clinician, and every basic scientist with an interest in clinical disease, needs an understanding of neuroanatomy. Stroke remains the most frequent cause of death in most industrialized societies; mood disorders such as depression affect more than 1 person in 10; and clinical dysfunction of the nervous system occurs in 25% of patients in most general hospital settings at some time during their hospital stay. An understanding of neuroanatomy is crucial not only for neurologists, neurosurgeons, and psychiatrists but also for clinicians in all subspecialties, since patients of every stripe will present situations that require an understanding of the nervous system, its structure, and its function.
This book, now in its 27th edition, is designed as an accessible, easy-to-remember synopsis of neuroanatomy and its functional and clinical implications. Since many of us learn and remember better when material is presented visually, this book is well illustrated not only with clinical material such as brain scans and pathological specimens but also with hundreds of diagrams and tables that are designed to be clear, explicative, and memorable. This book is not meant to supplant longer, comprehensive handbooks on neuroscience and neuroanatomy. On the contrary, it has been designed to provide a manageable and concise overview for busy medical students and residents, as well as trainees in health-related fields such as physical therapy; graduate students and postdoctoral fellows with an interest in neuroanatomy and its functional underpinnings; and clinicians in practice, for whom minutes are precious.
This book is unique in containing a section entitled “Introduction to Clinical Thinking,” which introduces the reader, early in the text, to the logical processes involved in using neuroanatomy as a basis for thinking about patients. Since some trainees remember patients better than isolated facts, I have included discussions of clinical correlates and clinical illustrations that synthesize the most important characteristics of patients selected from an extensive clinical experience. Also included are illustrative clinical images including computer tomography (CT) and magnetic resonance imaging (MRI), both of normal brain and spinal cord, and of common clinical entities that trainees will likely encounter.
As with past editions, I owe a debt of gratitude to many colleagues and friends, especially members of the Department of Neurology at Yale Medical School. Joachim Baehring, MD, and Joseph Schindler, MD, of Yale, as well as Catharina Faber, MD, at the University of Maastricht contributed invaluable clinical illustrations. Over the years, these colleagues and friends have helped to create an environment where learning is fun, a motif that I have woven into this book. I hope that readers will join me in finding that neuroanatomy, which provides much of the foundation for both neuroscience and clinical medicine, can be enjoyable, memorable, and easily learned.
Stephen G. Waxman, MD, PhD
New Haven, Connecticut