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The clinical practice of critical care neurology
  1. R Howard

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    Eelco F M Wijdicks. Published by Oxford University Press, Oxford, 2003, pp 579, £95.00 (hardback, 2nd edn). ISBN 0-19-515729-X

    It was once said of the English cricket team “they played well but the only trouble is that they can’t bat, can’t bowl and can’t field”. In the United Kingdom we make similar comments about neurological intensive care—it’s a good idea and important but we have no units, no specialists, and no training. This is, of course, an exaggeration but we continue to fall further behind the United States and Europe in the provision of care for patients acutely ill with neurological disorders. It must be shown that these units make a difference to the outcome of patients but it is both intuitively obvious and reflected in evidence-based medicine that providing the best environment for care will lead to better outcome. Wijdicks, together with others, has defined the field of neurological critical care with his textbooks and original contributions. The clinical practice of critical care neurology is a landmark in the field and the rapid publication of an enlarged and improved second edition reflects the importance of this book. Wijdicks writes from an extensive experience of managing patients with critical neurological illness. The book has all the advantages of a single author text, being coherent and logical with a thorough coverage of the subject. The layout of the second edition is a considerable improvement—the text is easier to follow and many of the practical procedures are more clearly described and illustrated. The book is divided into six sections, three deal with general aspects of neurological intensive care, discussing the practical details of setting up and running a neurological intensive care unit; the equipment and technology used in monitoring and treating the patients; and the clinical and ethical issues at the end of life. The major part of the book deals with the management of specific disorders, post-operative complications, and the management of the systemic complications seen in these patients. It is inevitable that there will be individual quibbles in such a wide ranging review of neurological management but the majority of these reflect different “fashions” between the United States and the United Kingdom rather than any fundamental differences in the interpretation of the evidence base.

    Neurological intensive care is a subspecialty where the clinician has to cover a broad spectrum of the specialty and this is superbly reflected in the second edition of Wijdicks’ textbook. A single author monograph of this sort cannot hope to be exhaustive but Wijdicks has achieved a remarkable job of ensuring detail is not compromised despite the breadth of coverage. This book provides essential reading and reference for all neurologists and intensivists charged with the management of patients on intensive treatment units with primary neurological disorders.