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Principles and practices of emergency neurology—handbook for emergency physicians
  1. D E Bateman

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    S M Shah, K M Kelly. Oxford: Oxford University Press, 2003, pp 454, £40.00, (paperback). ISBN 0521009804

    This is a handbook based on an earlier larger book, Emergency neurology: principles and practice, in response to enquiries from emergency medicine residents about whether a handbook, based on this main text, would be available. This is the result. Whether it is justified in calling itself a handbook is hard to say. The area covers three of my hands (small!). It runs to over 400 pages with approximately 50 authors. It covers neurological examination and neurodiagnostic testing, common neurological presentations, for example headache and weakness, specific neurological conditions, for example multiple sclerosis and cerebrovascular disease, neurological trauma, paediatric neurological emergencies, pregnancy related neurological emergencies, neurotoxicology, and brain death. So, it attempts a comprehensive coverage.

    The editors consider it to be symptom based, although this is not always achieved. It has many tables, good illustrations, and management of algorithms with “pearls and pit falls” at the end of every chapter.

    The neurological examination is done poorly, particularly the cranial nerves. This needs to be done with pictures of the lesions, their causes, and the anatomy, based around the common emergency presentations in A&E. Although British neurologists would disagree with some of the advice given, most of the text is reliable and clear. (For instance, in the chapter on myasthenia gravis, it states “useful gauges include pulse oximetry, peak expiratory flow and PCO2 measurement”, which are all poor gauges of impending ventilatory failure and vital capacity is the most important measurement in this respect.)

    The most disappointing feature is that the chapters are not adequately focused on emergency conditions. The chapter on movement disorders covers virtually the whole spectrum of chronic movement disorders without specifically concentrating on the common acute presentations, such as drug induced dystonia with oculogyric crisis and hemiballismus, which are likely to come to A&E. Unfortunately the editors and authors have failed to produce a sufficiently concise account of emergency conditions to make this book really useful. It needs to be much briefer and appropriately focused to achieve its aim and it would be better as a pocket book, similar to the edition of the Oxford text of medicine, which seems to occupy the pockets of most medical students! If only we could achieve the same for the pockets of medical SHOs in emergency neurology, things might improve!