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Principles and practice of neuropathology, second edition
  1. S Betmouni

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    Edited by James S Nelson, Hernando Mena, Joseph E Parisi, and Sydney S Schochet. Published by Oxford University Press, Oxford, 2003, pp 577, £145.00 (hardback). ISBN 0-19-512589-4

    A comprehensive textbook of neuropathology, which will appeal to those involved in any of the clinical neuroscience disciplines. It starts with a general introduction to neuropathology, covering basic techniques (for example, autopsy methods, fixation of tissue, and diagnostic stains) and general reactions of the CNS to injury. A useful chapter summarising CT and MRI neuroimaging techniques and basic interpretation of scans follows. Chapter three describes the embryological, fetal, and post-natal development of the brain, and outlines abnormalities arising as a failure of normal neurodevelopment. It is disappointing that no figures illustrating the neuroembryology were included, as this would have made it far easier to follow the sequence of neurodevelopmental events. In fact, this chapter as a whole would have benefited from more diagrams/illustrations. A concise, well written chapter covers a range of bacterial, fungal, parasitic, and protozoal infections of the CNS. Much of the information is supported by MRI imaging, and adequate photomicrographs of illustrating individual organisms and/or their effects in the CNS. Apropos infectious diseases, it is a pity that prion diseases are included in a chapter on viral diseases of the CNS. Not many people would still categorise the prion diseases as “slow virus infections” and I think that this section would have been more appropriately included in a subsequent chapter on neurodegenerative conditions.

    Chapter six, on AIDS, is a well written chapter covering various aspects of HIV infection, including an introduction to retroviruses, mechanism of entry of HIV into the CNS, the associated neuropathology (including peripheral neuropathy, myopathies, and myelopathy), and a description of opportunistic infections affecting the CNS. A good range of macroscopic and microscopic photomicrographs is included. This chapter provides a good overview of this topic.

    Cerebrovascular disease is discussed in chapters seven and eight. Chapter seven deals with the definitions of global and focal ischaemia, some common causes of each, and the consequent neuropathological changes. A useful timetable of macroscopic and microscopic changes in stroke is included. Some repetition follows in chapter eight, which also has information on subarachnoid haemorrhage, amyloid angiopathy, vascular malformation, and vasculopathies. Chapter eight includes a good summary of a number of aetiological factors that contribute to cerebrovascular disease. The chapter on intoxicants and metabolic diseases of the CNS provides a general introduction to neurotoxicology, including a reprise of the effects of hypoxia discussed in a previous chapter.

    A comprehensive overview of traumatic CNS injury, including head injuries of infants and young children, is presented in chapter nine, which also covers a number of practical issues that arise in relation to the neuropathological assessment of head injury.

    Although chapter 11, on neurodegenerative diseases apart from Alzheimer’s disease, does not cover an exhaustive list of neurodegenerative conditions, it does provide a competent summary of this area of neuropathology. An independent chapter is devoted to Alzheimer’s disease. This chapter is well structured and includes a number of photomicrographs illustrating the pathological changes in Alzheimer’s disease and a very brief discussion of its pathogenesis. The chapter on diseases of CNS myelin is yet another brief summary of a large topic. The bulk of the chapter concerns multiple sclerosis, with a relatively full discussion of its pathogenesis. Other demyelinating and dysmyelinating diseases are also covered, with a useful emphasis on clinicopathological correlation.

    Chapter 14 provides a very brief introduction to neuro-oncology and is essentially just an outline of CNS tumours. Chapter 15 is a very good practical chapter, containing helpful tips on the use and pitfalls of antibody panels in the diagnosis of brain tumours. Subsequent chapters on CNS tumours provide an excellent overview of this extensive topic. The chapters on non-neoplastic spinal cord, peripheral nerve, and neuromuscular pathology provide acceptable coverage for a book of this size.

    This is not a particularly long book and I found it easy to read. Many of the chapters have a practical emphasis. Most entities are covered in adequate detail for the non-neuropathologist. Although neuropathology trainees would find this book a useful introduction to their subject, they would also need to make use of specialist neuropathology textbooks, for example of tumour, muscle, and nerve pathology. The quality of micrographs is in general good but the book suffers in some chapters from a lack of good quality line drawings or illustrations. This was especially noticeable in the chapter on developmental and perinatal neuropathology.

    Overall, this is a practical and readable textbook, successful in summarising a large subject, and useful as a reference book for those in the clinical neurosciences and as an introductory textbook for those wishing to specialise in neuropathology.

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