Neurology In Clinical Practice 4th Edn

Walter G Bradley, Robert B Daroff, Gerald M Fenichel and Joseph Jankovic Published by Butterworth Heinemann, London ISBN 0 7506 7469 5 Price: £300.00 2512 pp

This is the fourth edition of a book which first came out in 1990. The editors are to be congratulated on producing a text book which covers all the clinical neurosciences, gives good clinical descriptions, pathophysiology, diagnosis and management. This, fourth, edition has been completely rewritten and new chapters are provided on endovascular surgery, mitochondrial and ion channel disorders. There are 175 contributors, mostly from the United States but there are also contributions from India, Canada, England, Ireland and Australia.

The book is presented in two volumes: Volume I deals with principles of diagnosis and management, and Volume II deals with the neurological disorders. The first part of Volume I ‘Approach to Common Neurological Problems’, covers diagnosis of neurological disease and problems such as episodic impairment of consciousness including drop attacks, delirium, stupor and coma, intellectual and memory impairment, behaviour and personality disturbances, depression and psychosis, etc. Part II of the first Volume deals with neurological investigations and related clinical neurosciences and this part includes laboratory investigation, clinical neurophysiology, neuroimaging, neuropsychology, neuroopthalmology, neurootology, neurourology, epidemiology, etc. This part ends with a chapter on the principles and practices of neurological rehabilitation. Volume II is devoted to the neurological disorders. This covers the whole of neurological diseases including the neurological complications of systemic disease in adults and in children, trauma, vascular diseases, cancer, infections, deficiency diseases, etc.

The work is extraordinarily comprehensive. It is well-written throughout and has excellent illustrations. The chapter on Spinal Cord Syndromes is somewhat misleadingly entitled ‘Paraplegia and Spinal Cord Syndromes’, but does actually go as high as the foramen magnum. The section on Spinal Shock is not well done. In Volume II trauma of the nervous system is dealt with in greater detail and there is a very good section on spinal cord trauma, but, again, the section on spinal shock is fairly superficial. This section starts by stating that spinal cord injury is one of the most common clinical entities encountered by the neurologist and neurosurgeon. This is surely incorrect. The authors give the incidence of SCI as approximately 40 cases per million people (ranging from 11.5 to 53.4 cases per million). Multiple sclerosis is 60 per 100,000 in Europe and the Northern United States and Southern Canada.

The chapter on ‘Neurourology’ serves as an example of the very high standard of this work. This chapter includes physical examination, investigations including urodynamic studies and neurophysiological and neuroimaging investigations, the management of bladder disorders and the management of neurogenic sexual dysfunction and faecal incontinence.

The book is highly recommended.