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Neurologic emergencies. A symptom orientated approach, 2nd edn
  1. D J Dick

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    G L Henry, N Little, A Jagoda, and T R Pellegrin. New York: McGraw-Hill Professional, 2003, $59.95, pp 346. ISBN 0-07-140292-6

    This is the second edition of Neurologic emergencies, a book which I imagine is aimed at physicians responsible for the emergency care of neurological problems, although this is never explicitly stated by the authors. It has a refreshingly practical approach and my initial irritation at the title was quickly dispelled by a preface pronouncing that “the days of the knee jerk CT may be drawing to a close”. I live in hope. The first few chapters set out the basics of neuroanatomy and the evaluation of neurological symptoms but thereafter they are symptom based with sections on acute weakness, headache, visual disturbance and loss, psychogenic symptoms, dizziness, and seizures. I am sure this is the right approach but it does occasionally lead to problems with cross referencing. For example, pituitary apoplexy, which rightly appears as a cause of visual loss, is hardly mentioned as a cause of acute headache mimicking subarachnoid haemorrhage. Similarly, non-organic seizures are discussed in the very good chapter dealing with psychogenic neurological symptoms but is hardly mentioned in the epilepsy section where they might be more appropriately placed. The book has some odd omissions—no mention of the usefulness of deep tendon reflexes in determining the level of spinal cord disease or of measuring prostate specific antigen in metastatic disease of the spine. The authors also assert that arterial dissection is a rare event, which is not my experience from managing an acute neurological intake. However, these criticisms are in the detail and overall I thought this was a comprehensive account of neurological emergencies and their management. I particularly liked the chapter on psychogenic neurological symptoms, which articulates something we are perhaps rather reluctant to admit to, ”it is a legitimate use of the neurological examination to communicate to the patient that the examiner does truly possess a sophisticated knowledge of the nervous system which will in turn lead to trust and confidence in the examining physician”. This book will be useful to all those who deal with neurological emergencies. In the UK I can see it appealing to casualty officers and physicians in training but I suspect a neurological readership would find it unfulfilling.

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