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Edited by E F M Wijdicks. 2004: Published by Oxford University Press, Oxford £70.00 (hardback), pp 306. ISBN 0-19-516880-1
Neurological conditions in the emergency department have to be quickly identified because more and more therapeutic options are available. Most of the academic approaches focus on diseases. Wijdicks offers an interesting and very practical insight of neurology in the emergency room. This is the second edition of catastrophic neurological disorders in the emergency department, third book of a trilogy dedicated to critical care neurology. Eight new chapters were added, seven of which appear in an entirely new first section on the evaluation of presenting symptoms indicating urgency. There is a final new chapter on forensic neurology.
The first part is original and very practical: from the initial symptoms in the emergency room such as “confused and febrile”, the evaluation of the patient, diagnosis orientation, algorithms for the choice of paraclinical tools, and therapeutic issues are discussed. One of the chapters I really found original is the one entitled “Shortness of breath”. This question is not often taken into account in teaching regarding neurological disorders. If you look for more precise data, you will find “little boxes” that point out to more precise issues such as the role of the ascending reticular activating system.
The second part is about how to evaluate conditions that can deteriorate (coma, acute obstructive hydrocephalus, brain oedema). The chapter on coma is exhaustive, with illustrations and figures commenting on different mechanisms. Toxicology is also very present in this book.
The last part is more conventional and deals with most of the urgent neurological conditions such as ischaemic stroke, haemorrhagic stroke, and spinal cord injury. Unfortunately, the author did not integrate a chapter on myasthenia or Guillain-Barré syndrome, which are often under-recognised in the emergency department.
There are different levels of reading whether one searches for general data on a disease, differential diagnoses, or more precise elements such as a reference or pathophysiological explanations. Illustrations are very helpful; in particular, the ones on oculomotor disturbances and neuroradiological resources are well chosen. This book can also be an excellent source of inspiration for teaching.
All the doctors (from students to consultants) who have to walk through an emergency department should have this book on their bookshelves. A pocket edition of such an educational book would be useful!
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