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Mild Head Injury. A Guide to Management.

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    Mild Head Injury. A Guide to Management. By philip wrightsonand dorothy gronwall. (Pp 182). Published By Oxford University Press, Oxford, 1999. ISBN 0-19-262939-5.

    Mild head injury presents the neurosurgeon with several dilemmas. Those of us who see head injury cases for the purposes of medicolegal reports have even greater problems with the topic. In particular, any statistics relating to the frequency of the condition or its possible complications are likely to be unreliable as many patients who sustain mild head injuries may never be referred to neurosurgeons or even to hospital. Of those who do get admitted, in many cases the primary injury is to another body system and the coexistence of mild head injury is consequently ignored. Similarly, those patients who have continuing neurological symptoms after mild head injury may not readily come to the notice of the neurosurgeon. At best, therefore, all scientific papers and other reports which purport to give the incidence of this condition or of its complications should carry a health warning “to be treated with great caution”. However, this guide to the management of mild head injury begins in an admirable way by establishing carefully both the basis on which its statistics are derived and its authors' own definition of what they mean by “mild head injury”. Thus the statistics which these authors provide are likely to prove more reliable than most. Their careful studies indicate a probable incidence of 3% of persisting symptoms 28 days or more after mild head injury.

    Although the view that the “post-traumatic” or “postconcussion” syndrome is a “litigation induced neurosis” still has some currency, particularly in legal circles, there are now sufficient pathological and imaging studies to agree a probable pathological basis for the syndrome. This volume sets out the evidence for such a case in a clear and lucid manner including some mention of the more recent MRI and SPECT evidence. Similarly, the more recent work undertaken by clinical psychologists carrying out detailed psychometric assessments of these patients has provided good supportive evidence for the reality of the continuing cognitive and performance problems that such patients have, often for prolonged periods after an apparently mild injury. The authors present a wealth of clinical and psychological data in a clear and lucid manner and the layout progresses naturally to the helpful chapters on assessment and management. The prose style is good, the points the authors wish to make are clearly presented, and the book as a whole is helpful and inclusive. It might usefully have been more lavishly illustrated—for example, by some of the more impressive pathological material. I consider it to have earned a place on my bookshelf and I can recommend it for all those of us who have an interest in this condition and its often unfortunate consequences.