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Neurological emergencies, 4th edn
  1. P E M Smith

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    R A C Hughes, ed. London: BMJ Books, 2003, pp 496, £45.00 (paperback). ISBN 0-7279-1774-9

    Medical SHOs’ training only infrequently includes a dedicated attachment to neurology. Routine neurology then seems daunting enough, but neurological emergencies may appear a worst nightmare. This updated compilation of 13 reviews covers common neurological emergencies in surprising detail. Most practically useful are those focused on presenting symptoms, such as medical coma and acute visual loss. Stroke and status epilepticus are treated authoritatively, but first seizure, a common emergency referral, is not included. Subarachnoid haemorrhage is well presented but may have been even more useful if considered as one cause of acute headache. Brain stem death criteria are described clearly but, if emergency means cannot wait until morning, their inclusion is unexpected. The summaries concluding each chapter are disappointingly printed black on dark grey, in smaller type than the text, hard to read even in daylight. Perhaps the publishers intended it, but these summaries will not readily copy for handy laminated reference in the emergency unit.

    Neurological emergencies is too large for the white coat pocket (nearly 500 pages), and too longhand for last minute reference behind the patient’s curtain. Its style is detailed prose rather than notes and bullets. Nevertheless, this book will usefully inform clinicians of all grades and increase the likelihood that neurological patients are managed safely. At £45 there may be only one departmental copy, but that must be on the registrar’s bookshelf. At risk of stating the obvious, the book should be digested, calmly, away from the coalface, before the emergency presents. Then those faced with serious neurological situations need not echo Arthur Dent in Hitchhiker’s Guide to the Galaxy, ““It’s at times like this […] that I really wish I’d listened to what my mother told me when I was young.” “Why, what did she tell you?” “I don’t know, I didn’t listen.””

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