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Brain's diseases of the nervous system, 11th edn
  1. Lionel Ginsberg

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    Edited by M Donaghy (Pp 1242, £150.00). Published by Oxford University Press, Oxford, 2001. ISBN 0192626183

    Lord Brain left us two neurological textbooks. The smaller, Brain's clinical neurology, subsequently revised by Sir Roger Bannister, is known affectionately as “Little Brain”. Diseases of the nervous system, or “Big Brain”, remained a single author work until the 9th edition. By then, it had passed into the hands of Lord Walton, who brought in 12 coauthors for the 10th edition. This 11th edition, completely revised under the new leadership of Michael Donaghy, has contributions from 14 authors, all working in British institutions.

    The decision to continue with relatively few contributors, all from the same country, might have laid the book open to charges of being parochial or elitist. However, the result is a volume with a cohesive style where unnecessary overlap has largely been avoided and omissions are few.

    Even nowadays, there is only a handful of standard neurology reference texts, so comparisons are inevitable, in particular with Neurology in clinical practice by Bradley et al. Brain's diseases has the signal advantage over Neurology in clinical practice of being contained within a single volume, albeit one large enough to disperse a ganglion more efficiently than any family Bible.

    The arrangement of chapters in this edition of Brain's diseases is as logical as in any other major text—Lord Brain himself acknowledged in the first edition that there is no easy answer to this problem. After an introductory section, the book is effectively a series of monographs on diseases of the cranial and peripheral nerves and muscle, then structural disease of the neuraxis, followed by epilepsy, coma, and dementia. Finally, the major pathological processes are described: vascular, demyelinating, inflammatory, degenerative, and infective.

    Generally, these topics are covered with great authority, wisdom, and scholarship. So criticism of this icon of British neurology may seem unchivalrous but here are some minor comments. Firstly, regarding style, in striving to avoid dryness the authors are occasionally unduly colloquial (“Nonsense!” 85) or hectoring (“Whatever else, it is important for neurologists to . . .” 899).

    As for content, there are a few lapses. In particular, discussion of the pathophysiology of symptoms and signs lacks depth: Hughlings Jackson would have baulked at the definition of positive symptoms given on 13. With a book of this size, there is bound to be some variation in quality and the chapter on vasculitis and collagen vascular disorders is weaker than the rest. Though these conditions are relatively rare, their management is important, as it frequently vexes neurologists. It is simply inadequate to dismiss their classification as unsatisfactory and end the brief discussion of this topic with the implication that they can all be lumped together anyway, as the treatment is usually immunosuppression. In the same section, lupus and the antiphospholipid syndrome are given as examples of the difficulty of accurate subclassification. But this is one situation where there are clear differences in treatment—that is, immunosuppression versus antiplatelet therapy and/or anticoagulation. Later in the same chapter, eosinophilia is given as a feature of Wegener's granulomatosis yet is mysteriously omitted from the adjacent paragraph on Churg-Strauss syndrome.

    Consistent nomenclature is always a concern in large multiauthored texts. Here, there are predictable difficulties with the hereditary neuropathies and with what to call idiopathic brachial plexopathy—the author plumping for the rather antiquated “acute brachial neuritis”. It is a pity that the one disease for which the British can claim special expertise—the human form of bovine spongiform encephalopathy—goes under two names, “variant Creutzfeldt-Jakob disease” in the section on dementia and “new variant Creutzfeldt-Jakob disease” in that on infection.

    Finally, there are typographical errors, which are too many for comfort, especially in the tables, figures, and references, giving the impression that the book was rushed in its final production stages. Perhaps the most alarming was the discovery of a new cranial nerve, the 13th, in table 1.4. Figure 8.5 shows a retinal hamartoma, not haematoma. Figure 8.4 shows the optic fundus at an unusual angle. Figure 11.9 is anatomically incorrect. Figures 7.3 and 29.11 are too small. The caption to figure 2.23 is incomprehensible. Many other examples could be given.

    But these are mainly minor quibbles, easily rectified when the book is reprinted. Taken as a whole, Big Brain is alive and well, and safe in the hands of its new editor and his coauthors.

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