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Clinical neuroanatomy for medical students, 5th edition

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Clinical neuroanatomy for medical students, 5th edition. By richard s snell (Pp 545, £29.95). Published by Lippincott Williams and Wilkins, Baltimore, 2001. ISBN 0 7817 2831 2.

Richard Snell's Clinical anatomy for medical students is a successful clinically oriented text that contains essential facts and explanations without excessive detail. His parallel neuroanatomical text has similar aims.

Each chapter begins with chapter objectives; these are actually a brief explanation of broad aims for learning rather than specific educational objectives. There follow the main anatomical information of the chapter. New terms are printed in bold text, a style that is less than effective as attention is drawn to these rather than to key points of understanding. Next comes an extensive section of clinical notes that constitute the greatest strength of the book. They make clear the ways in which anatomical knowledge underpins diagnosis and management, and provide the student with valuable motivation to gain control of the key facts. Understanding is then tested by a set of clinical problem solving scenarios with answers. The last element is a set of review questions in a multiple choice format, many of which test topographical neuroanatomy at an excessively detailed level.

The first three chapters cover gross anatomy and cell biology of the nervous system and the fundamentals of nervous system function. These take things fairly gently and a good deal of the material will be familiar to a medical student who already has a reasonable knowledge of anatomy and physiology. The material in the functional chapter in particular is rather variable in level and quality.

The next four chapters provide a fairly conventional ascending regional treatment of the CNS from spinal cord through brain stem and cerebellum to cerebrum. The author's intention to provide an essential core of knowledge has here been overwhelmed by reluctance to leave anything out.

The next nine chapters are much better. These deal with the nervous system in a systems based way, covering such themes as cortical organisation, the reticular formation, the limbic system, and the hypothalamus, with balance and clarity. The chapter on the autonomic system will help students who find the principles difficult, although it is disappointing that the afferent component of the parasympathetic system is not considered as an entity. The coverage of cranial nerves suffers from insufficient explanation of the components of a cranial nerve—the term “branchiomotor” is used but not explained. The final chapter, on development of the nervous system, seems to have been included for completeness rather than out of any conviction that it matters.

Illustrations are very variable in quality, with excellent three dimensional half tone drawings and good illustrations of pathways but some poor thumbnail sketches. Some illustrations have been recycled from the author's anatomy text without adaptation for their new context. Imaging material is varied and usually well chosen. The tables tend to be congested with information and are not likely to be found helpful.

The short time available for studying neuroanatomy in most curricula means that students tend to use textbooks to clarify the deficiencies of their lecture notes rather than for systematic reading. The index is fairly comprehensive and will usually take the reader to the right place.

In summary, Professor Snell has not yet produced the compact, clear guide to the anatomical basis of clinical neurology needed by modern medical students; the message is still buried in excessive anatomical detail and terminology. However, his book deserves recommendation for its clinical notes. These could provide the starting point for defining the core anatomical knowledge in a future edition.

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