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Central Nervous System Angitis

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    Central Nervous System Angitis. By james w schmidley. (Pp240, £70.00). Published by Butterworth Heinemann, Oxford, 2000. ISBN 0 7506 7153 X.

    Schmidley's book on CNS angiitis is an absolute gem. He concisely summarises the salient information about various rare and often puzzling conditions that affect the blood vessels of the brain. The writing is clear and lively and easy to read and digest. After summarising the data, Schmidley always lets the reader know where he stands on issues. He reviews the major common features of each condition and yet also mentions unusual and rare features and often illustrates with exerpts from individual patients.

    The book begins with a rather in depth but concise review of the clinical and pathological features and the diagnosis and treatment of isolated CNS angiits. Included is an excellent chapter on pathogenesis which reviews complex immunological theories in a very readable summary form. Later chapters deal with postpartum angiitis, cases of supposed angiitis diagnosed by angiography, and various infectious and systemic and ocular disorders that have been posited or proved to include angiitis of the brain's vasculature. Coverage of individual disorders such as neurosarcoidosis, Behçet's disease, scleroderma, Eales' disease, etc includes concise but data rich summaries. The entire book covers 165 pages of text. The illustrations are excellent and there are many useful tables that contain summaries of the data. The reference list is extensive.

    Schmidley emphasises several very important points that are not widely known to neurologists. I mention only a few here. (1) Isolated CNS angiitis rarely presents as a stroke. (2) The angiographic findings that radiologists dub as vasculitis are quite non-specific and are found in various non-angiitic conditions. (3) Angiograms are often normal in patients with isolated CNS angiitis because the vessels (arteries and veins) involved are usually quite small and the brain imaging findings in this condition are very non-specific. Isolated CNS angiitis can only be confidently diagnosed by biopsy. (4) Stroke is almost never the first presentation of polyarteritis nodosa or temporal arteritis. (5) Most strokes in patients with lupus erythematosus are not attributable to a CNS vasculitis. (6) The brain lesions in Behçet's syndrome are probably related to a meningoencephalomyelitis rather than a true angiitis.

    I recommend this little book highly to all neurologists. It will prove very handy when confronted with difficult patients of undiagnosed brain diseases and will be useful when looking up the key findings and literature references in patients suspected of having any form of systemic or CNS angiitis.

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