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Neurological emergencies, 3rd edition
  1. DAVID J BURN

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    Neurological emergencies, 3rd edition. Edited by rac hughes. (Pp 399, £35.00.) Published by BMJ Books, London, 2000. ISBN 0 7279 1405 7

    This is the third edition of a book which stems from an original series of 12 articles on Neurological Emergencies, published by thisJournal in 1993. In this current edition there are 13 chapters; the “new addition” is the short final chapter by Dr O'Brien on criteria for diagnosing brain stem death. The titles of the other chapters have remained the same as they were in 1993 and cover a broad range of neurological, psychiatric, and neurosurgical emergencies. The authorship has changed remarkably little; but why change a winning team? The contributors are leading authorities in their respective topics.

    Each chapter has been updated where necessary and all are well referenced. The summary boxes are particularly useful. This combination of strengths is appropriate, as the text is clearly not intended to be exhaustive. In the acute situation, the tables of differential diagnoses (the chapter on acute neuromuscular respiratory paralysis deserves special mention in this regard), boxes devoted to management (I continue to find the section on management of tonic-clonic status epilepticus very helpful), and the flow charts (notably the prediction of outcome of coma—invaluable for the intensive care consultation) are quickly located and will be extremely useful. The text adds “meat to these bones”, but if more detailed information is required this could always be found from the references, hopefully after the crisis has passed.

    From the title of the book, it will be purchased by predominantly neurologists. Thus, the chapters on traumatic brain injury and raised intracranial pressure may be less often read than the others. This is a pity, as these issues are well covered and have been extensively revised and updated.

    There are always going to be minor quibbles with omissions and the relative weighting of topics from a multiauthor book such as this. I could not, for instance, find any reference to the diagnosis and management of neuroleptic malignant syndrome. It could be argued perhaps that more space could have been devoted to HIV infection and its management than the three pages allocated, compared with twice this space on brain abscess.

    The book is compact and paperback, but will require a bag or briefcase for visits to the intensive care unit and accident and emergency department, as it is still too large to be accommodated by most white coat pockets. A strong case could also be made for keeping a copy on the neurology (and neurosurgery) ward rather than in the library. Specialist registrars may well wish to invest in their own copy. In the next few years, due to a combination of changing junior doctors' hours and the finite duration of training imposed by our current training system, it might also be wise for the consultant to keep a copy on their bedside cabinet!

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