Brain, Vol. 125, No. 9, 2134,
September 2002
© 2002 Guarantors of Brain
Book Review |
DIFFERENTIAL DIAGNOSIS IN NEURO-ONCOLOGY
National Hospital for Neurology and Neurosurgery, London, UK
DIFFERENTIAL DIAGNOSIS IN NEURO-ONCOLOGY
By Jerzy Hildebrand and Michael Brada
2001. Oxford: Oxford University Press
Price £59.50. pp. 310. ISBN 0192632132.
Neuro-oncology is a Cinderella speciality in British neurology yet almost every neurologist will be asked to see patients with neurological complications of cancer and with primary and secondary brain tumours. The importance of an early and accurate diagnosis cannot be overstated particularly as most neurological lesions in cancer patients are rapidly progressive and potentially life threatening. One in five patients with metastatic cancer develop neurological complications and although the majority of neurological problems are a direct consequence of metastasis or metabolic derangement, the diagnostic considerations need to include treatment-related complications and paraneoplastic syndromes. Knowledge of these additional differentials is therefore essential and yet there is no easy reference guide for the jobbing neurologist apart from Posner’s seminal work Neurological Compli cations of Cancer.
Differential Diagnosis in Neuro-oncology has been written by a Belgian neurologist (Hildebrand) and a British oncologist (Brada) and aims to help the clinician to identify and locate the underlying neurological lesion in a cancer patient and institute appropriate therapy. This book brings a unique perspective to an enormous subject because it uses a functional anatomical approach rather than a disease-based one. Therefore chapter headings include ‘Altered Consciousness’, ‘Epileptic Seizures’ and ‘Cerebellar Dysfunction’ and each chapter consists of the same subheadings—Introduction, Clinical presentation, Main aetiologies, Investigations, Therapy and References. The final chapter on ‘Therapy of the Main Neurological Malignant Diseases’ is devoted to the management of the most common primary and metastatic tumours affecting the nervous system and provides an excellent overview of the main treatment options for brain tumours based on a thorough review of the literature.
The emphasis of the book is on the identification of the more common and potentially treatable conditions and is recommended reading for neurologists, neurosurgeons and oncologists who manage this patient group. It contains a wealth of information that will be new to many and it is presented in a logical and readable format.
There are plenty of gems in this book to inform even the most experienced neurologists. For example, mental changes are the most frequent initial manifestation of leptomeningeal metastases and this is an important diagnostic consideration in a patient with apparently normal neuro-imaging. Another example is that vincristine may cause recurrent laryngeal, oculomotor and facial nerve palsies and an ataxic patient with cancer and a normal brain MRI may be harbouring epidural metastases compressing the posterior spinal cord.
The strength of this book lies in the ability of the authors to condense many years of combined experience into a small number of succinct chapters and to clarify areas of controversy within the boundaries of the literature. The book is scattered with useful diagnostic and therapeutic algorithms and well-referenced tables and there is a small collection of 10 colour plates in the middle to illustrate interesting intra-ocular malignancies, a peripheral nerve tumour and an example of stereotactic planning for the removal of a brain tumour.
My main criticism of the book lies in the variable quality of some of the prose and lack of attention to detail particularly in the references and some of the tables. It is disappointing that the first table in the book listing the different neurological features which help distinguish between coma from a primary brain lesion and coma from a metabolic or toxic disorder should be so difficult to follow. In addition, there is considerable duplication of subject matter and references across and between chapters which could have been improved by tighter editorial control. The quality of the illustrations is variable and there is some duplication of colour and black and white plates, which add little to the overall work. Nevertheless, these are small quibbles and the overall impression is of a carefully thought out and thorough practical guide to everyday clinical problems in neuro-oncology practice.
Priced at under £60 for a 300-page hardback book with colour illustrations, this is a worthwhile investment and I would not hesitate to recommend it—indeed I had already obtained my copy before being asked to review it.
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