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Critical care neurology and neurosurgery
  1. R Howard

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    Edited by Jose I Suarez. Totowa: Published by Humana Press, 2004, $145.00 (hardback), pp 611. ISBN 1-58829-089-1

    This is a worthy attempt to produce a comprehensive multi-author text of neurological and neurosurgical ITU. The volume is extensive with more than 60 authors contributing 34 chapters in over 600 pages. The scope is wide ranging and covers a broad sweep of topics relating to critical illness due to primary neurological and neurosurgical conditions. It has little or nothing to say about the neurological complications of general medical intensive care.

    There are many excellent individual chapters—I learnt a great deal from the neurosurgical contributions concerning raised intracranial pressure and monitoring, and also from the neurological section on vascular disease. However, there are surprising omissions; for example, as general neurologists we are probably asked to consult about ischaemic-hypoxic brain injury more than any other single condition and yet this book has little concerning this important topic. There is a relatively little about the practical aspects of management although there are honourable exceptions and I particularly enjoyed the section on ventilation and tracheostomy. A more up to date description of central respiratory abnormalities due to neurological disorders would have been preferable. Does anybody really see the patterns of central herniation described by Plum? In the modern world ventilation is introduced much earlier and these descriptions are generally of historic interest only. For such a comprehensive text I would have preferred a little more about the history and philosophy of neurological intensive care—particularly a recognition of the different sorts of units related to stroke and long term ventilatory management.

    This book attempts to present an overview of the subject, including chapters on most aspects of neurological critical care, but unfortunately the structure is rather loose and the content is organised without an obvious overall strategy. This is a disappointment and rather dilutes the value of this book as a textbook. It is relatively expensive and I was disappointed by the poor quality of the illustrations. It is surely essential in the modern world of neuro-imaging within the ITU to be presented with high quality reproduction of functional imaging in addition to more conventional modalities. Similarly, the lack of structure demands a more coherent presentation of individual chapters making better use of tables and figures.

    There are several excellent new texts of critical care neurology and neurosurgery against which this book must be measured. The lack of structure and organisation means that it falls short of the more coherent books written by single authors or small groups. The book will be an asset to specialist neuro-critical care units but is unlikely to be of value to general neurologists or trainees.