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Neuroanatomical basis of clinical neurology
  1. Jan Van Gijn

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    By Orhan Arslan (Pp 432, £33.99). Published by Parthenon Publishing, Lancaster, 2001. ISBN 1 85070 578

    Medical students find neuroanatomy difficult and often boring. A ruse that many teachers use is to refer to clinical implications. The author of this book has tried to condense that method into print. A classically organised, heavily illustrated text of neuroanatomy has been sprinkled with clinical vignettes, printed in blue. Sadly enough the result is disappointing. Firstly, the neurological vignettes are rather haphazardly chosen and often too long. In the section on the temporal lobe a single blue column throws together uncal herniation, Cheyne-Stokes respiration (sic!), uncinate fits, and Pick's disease. Secondly, the neurophysiological perspective, found in several other neuroscience textbooks for undergraduates, is dearly missing here. The problem is most sorely felt in the chapter on the reticular formation, where utter confusion reigns on disturbances of consciousness and its anatomical substrate. Thirdly, vignettes consist almost entirely of bare text; the few drawings of clinical signs are at best poor and often erroneous (there is no “ape hand” in carpal tunnel syndrome and chorea is chorea, whether Huntington's or Sydenham's). Lastly, more slip-ups occur in the text. Torticollis is said to be caused by muscle contracture, subarachnoid haemorrhage would usually be accompanied by aortic coarctation and polycystic kidney disease, and gliomas would become manifest mostly through headache and vomiting—to name a few.

    What about the core of neuroanatomy? The magnetic resonance images are a nice feature but as always the book contains far more facts—such as the good old rubrospinal tract—than one has ever needed in decades of clinical practice. Even worse, some useful anatomical facts are missing: not only the caudal loop of central neurones to the facial nucleus but even perforating arteries and their relation to lacunar infarcts. In brief, neuroanatomy books should be written by clinicians, not the other way around.