Brain, Vol. 122, No. 7, 1391-1392,
July 1999
© 1999 Oxford University Press
Book Reviews |
COMPREHENSIVE NEUROLOGY.
By Roger N. Rosenberg and David E. Pleasure. 1998. Chichester: John Wiley and Sons Ltd.Price £145. ISBN 0-471-16958-7..
Consulting Rooms, The Coach House, 1A College Road, Exeter, UK
This reviewer from a Neurology Centre in the United Kingdom is glad he did not spend £145 on this substantial neurology text book of 948 pages because, in keeping with usual practice, he appreciates retention of the review copy as a useful reference source, quite easy to thumb through and read.
This is the second edition of a textbook first published in 1991, now comprised of 31 chapters and an astonishing 919 pages within a single volume—rarely has so much been owed by so many to so few. Fifty-six of the contributors come from the United States and the other two from Canada. The two editors combined for the initial chapter on molecular neurology and the first editor provides jointly another chapter on genetic neurological diseases.
A vital part of such a book is a short preface and a good index, the latter consisting of 27 pages which is nearly 3% of the total volume. The usual range of neurological disorders is dealt with comprehensively and topics progress by way of conventional logic from molecular considerations and disorders of the newborn through what might be called the head end of neurology, including vascular disease, headache, epilepsy and extrapyramidal disorders, then through the special senses of neuro-opthalmologic and neuro-otologic disorders, down the spinal cord and autonomic system to peripheral nerves, myasthenia gravis and muscle disease. However, this layout has its unusual features, mixing anatomy, pathology and age so some chapters do not appear logically in this hierarchical approach; for example multiple sclerosis and pregnancy appear almost at the end.
A popular way to review is to check for conditions found in everyday clinical neurological practice. A high quality index is essential in this exercise and most entries are readily accessible from this index. Fortunately the index avoids the annoying habit of referring the reader from one point to another before text can be accessed although not all topics are found easily. Visual scanning of an index (rather than by electronic word-search on a CD-ROM) leads by serendipity to unusual topics; is central razzle a bothersome sensation accompanying auditory stimuli and thought to be part of the thalamic syndrome appreciated commonly on the east side of the Atlantic? It appears here (and, like many unusual items, in Pryse-Phillips' very handy Companion to Clinical Neurology) but not in many other places. The index inevitably has some annoyances: chromosome does not merit an entry at all but genetics covers many diseases. The XXY syndrome and its posthumous relationship to epilepsy is not mentioned but the genetics of epilepsy is well-covered for a general text.
This reviewer liked the historical vignettes at the commencement of each section and the referencing by Harvard style, so that authors' names and publication dates can be read within the text rather than by reference to a numbered list. In this sense chapters are freestanding with references alphabetically at the end of each. This has led to duplicate cover of some topics and less than adequate cover of others.
Many of the black and white photographs are reproduced well but the few in colour considerably less pleasingly than the monochrome. Photographs of MR scans do not help greatly, due to photographic inadequacy rather than to the choice in many cases of primitive scan images that are too small and the labelling almost illegible. The depiction of ocular reflexes in coma and of the motor responses to painful stimuli would be helpful if they could be examined other than with the aid of a magnifying glass. By contrast, whole pages are devoted to tables for logging sleep and for standard neurological classifications of spinal cord injury which makes them legible and, copyright allowing, these could be useful additions to patients' medical records.
The line drawing of the cavernous sinus is helpful but the enhanced CT image which accompanies it does not do justice to modern imaging, and has been reproduced from a 1994 publication. The scan of bilateral acoustic neuroma in a patient with neurofibromatosis type II is another example of the problem. Better pictures might be expected in this 1998 textbook.
The approach to disorders of speech always provides a stiff test for any textbook and here is coalesced from a medley of topics; Broca's aphasia and Wernicke's aphasia head a list which continues with global aphasia, conduction aphasia, the transcortical aphasias (motor and sensory), subcortical aphasia, anomic aphasia, crossed aphasia, sign-language aphasia and progressive aphasias. This encyclopaedic approach classifies but without enough understanding of speech mechanisms this may not be such a criticism of a textbook but rather an illustration of the difficulties in understanding the anatomy and physiology of speech, leaving little alternative but to perpetuate the descriptive approach.
Minor aberrations of language are troublesome (more common is used too often in this book, commoner is equally erroneous) and some sentences are difficult to follow (controversy currently ranges whether the incidentally discovered lesion without current symptoms needs preemptive therapy). A tendency to use trade names, even the universal Tensilon and Prostigmin, is at variance with much current practice, although proper names are provided in brackets. The use of sildenafil gets the thumbs-up.
Not all neurologists might agree with the assertion that approximately 30% to 45% of cases of acute transverse myelitis occur after infection or vaccination, whereas 3% to 21% represent an exacerbation of multiple sclerosis, feeling the opposite attributes might be more appropriate. The earlier symptoms stated here, back pain and urinary retention, relate to the level of the lesion, whilst some may feel that pain is not all that frequent.
The pathology of peripheral neuropathy is well laid out and the electron micrographs good. The description of chronic inflammatory demyelinating polyneuropathy is helpful in the understanding of this confusing clinical entity. Hereditary motor and sensory neuropathies appear in chapters on genetic neurological diseases and on peripheral neuropathies. Careful editing might have weeded out discrepancies of this sort but, on the other hand, careful editing and writing have rendered the text startlingly short on spelling errors. Furthermore, more than one approach to a topic can be illuminating.
Syringomyelia appears under disorders of the spinal cord (which seems best) but also under genetic neurological disorders (which seems less appropriate, particularly since the Chiari type II abnormality is not mentioned there where, surely, it might be expected). Syringomyelia secondary to trauma receives brief mention but not in the section on spinal cord trauma (where a long description of calcium channel activity appears). Syrinx is noted in the differential diagnosis from intramedullary tumour but syrinx secondary to tumour seems to have escaped the attention it deserves, since many of the most important disorders in medicine are those for which some treatment is possible (and this is one).
Arachnoiditis does not appear in the index or in the section on radio-contrast agents in the chapter on toxic syndromes, although idiosyncratic reactions to iodipamide and other iodine-containing substances are said to occur. Should lumbar canal stenosis really appear in the chapter on diseases of the spinal cord?
Amyotrophic lateral sclerosis (ALS) is noted to affect both upper and lower motor neuron pathways and British readers understand this alternative terminology although they believe that the term amyotrophic really should mean lack of muscle wasting. Perhaps ALS should be redesignated myotrophic lateral sclerosis but that would lead to misconceptions too. In the differential diagnosis of motor neuron disease the need to exclude subacute combined degeneration, compressive lesions, old polio and other conditions rightly is emphasized. The important differential diagnosis of motor neuron disease and multifocal motor neuropathy with conduction block does not appear in the index and multifocal motor neuropathy with elevated anti-GM1 antibodies is described only in relation to monomelic antibodies; mention is not made of those cases in which more widespread involvement occurs and those in whom antibodies are negative, a very important group of patients who may respond to intravenous gamma globulin (and this is not included here).
Is thymectomy really offered to patients with generalized myasthenia in most centres once generalization is established?
The interferons are discussed in relation to the treatment of multiple sclerosis and, as in many textbooks, the advice here in relation to long term disability understandably is out of date (although the most recent reference here could perhaps have been to a paper later than 1993). The table comparing three trials (beta interferons 1A and 1B, copolymer 1) discusses the MR outcome but the references to these trials are not included in the table and the reader needs to infer these from the text, which might lead to error. Reliance is placed upon multiple sclerosis plaque volumes and new lesion rates which may not relate reliably to clinical presentation, this reviewer taking the opportunity again to air his hunch that perhaps lesions shown on MR are those where a good inflammatory reaction has occurred and where improvement may be expected, whereas others less prominent and without a good inflammatory reaction may result in greater damage with axon loss.
The chapters on toxic syndromes and the toxic biological basis of psychiatric disorders are helpful in the classification of these difficult disorders.
An enormous amount of information is packed into this single volume and it is good for reference. As a textbook for the progressive learning of neurology the layout is not ideal. Neurology in Clinical Practice, the two volume counterpart edited by Bradley and others and now also in its second edition, is laid out more logically (but such a comment might be expected from a British reviewer brought up in the so-called British tradition of neurology). Few large volumes now are other than multi-author and this has its strengths and weaknesses. Overall the textbook is valuable for this clinician, who is pleased to have a copy to add to his armamentarium for everyday clinical practice; many others will agree.
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