- Email: [email protected]
Acute Pediatric Neurology
e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y x x x ( 2 0 1 4 ) 1 e2
Official Journal of the European Paediatric Neurology Society
Book review Acute Pediatric Neurology, Thomas Sejersen, Ching H. Wang (Eds.). Springer-Verlag, London (2014). 405 pp., Hardcover V149.79, eBook V118.99, ISBN: 978-0-85729-490-6 (Print), ISBN: 978-0-85729-491-3 (Online).
Front line paediatricians, whether working in emergency departments, acute admissions, intensive care units or neurology on-calls, are not uncommonly faced with children with difficult to-diagnose and/or to-treat neurological disorders. Recognizing acute neurological presentations in children, stroke for instance, can be challenging leading at times, sadly, to either improper investigations or undertreatment.
Most current standard child neurology textbooks will contain topics on ‘acute’ or ‘emergency’ neurology; yet in a rather ‘textbook style’ or perhaps in a somewhat a ‘laboratory based escientist’s approach’, dare I say! Thus, a book that provides an authoritative, insightful, practical and concise clinical guide to hopefully overcome some of these challenges will be genuinely welcome. “Acute Pediatric Neurology” is probably here to serve this very purpose, one can safely claim. The book is divided into two parts. A symptom-oriented overview is presented in Part I detailing the important pathophysiological and clinical issues to be addressed when such symptoms are encountered. Part II, which spreads over 12 chapters, covers the management of acute neurological problems in an elegantly logical manner. Most chapters, if not all of them, are likeable and present the reader with a workable and down-to-earth problem-solving approach with a well-regarded emphasis on applying bedside clinical skills. For example, the chapter on acute disturbance of vision comes very handy to those of us who are not neuroophthalmologists but still find themselves having to figure out what is wrong with the child’s eyes who is seen during an outof-hours shift. Chapters on management are comprehensive and encompass wide areas. A good example is the chapter on status epilepticus where the authors take you from prehospital management through to the emergency department assessment and treatment algorithms and go beyond that to available treatment options for refractory cases such as immunotherapy, the ketogenic diet, surgery and so forth. That said, the chapter on the management of headaches focused, and rightly so, on the commoner forms of primary headaches; however it is a bit disappointing that other rare causes such as the trigeminal autonomic cephalalgias for example, are not covered. CNS infections, or the constant worries about them shall I say, are considered and empirically treated in many children with acute neurological presentations. A succinct account is given in this book covering a wide range of pathogens being it bacteria, viruses or even parasites such as plasmodium falciparum. Antimicrobial choices (or even their unproven benefit) and dosages are conveniently described although the authors have opted not to touch upon the ongoing controversy of steroids use. A slight criticism is the lack of mentioning of the so-called ‘para-infectious encephalopathies’ that are associated with common paediatric infections such as rotavirus and influenza. Another deficiency that the book suffers from is perhaps a section or two on the emerging important group of autoimmune encephalitides, the early recognition and aggressive treatment of which have been shown to improve outcomes.
2
e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y x x x ( 2 0 1 4 ) 1 e2
It is quite satisfying to see sections dedicated to the management of acute neuromuscular presentations such as myasthenic crisis, malignant hyperthermia and the periodic paralysis syndromes to name a few. Most readers will be delighted to see a whole chapter devoted to stroke and cerebrovascular diseases detailing the important tools that would aid the clinician to make a timely diagnosis and to put in motion management strategies. This chapter is written in a helpful ‘what-to- (and not to)-do’ style based on the currently available international evidence-based guidelines. The role of different neuroimaging modalities in different scenarios is cleverly described. With few exceptions, most chapters lack illustrative figures and diagrams, which could have arguably enhanced the educational value of the text immensely. However, there are still plenty of tables and ‘key points’ boxes that readers would find useful. One has to say that there is some inconsistency between some of the information given in some chapters. For instance, different cut off values for CSF opening pressure to diagnose paediatric idiopathic intracranial hypertension are described. Yet this might perhaps be a reflection of different authors’ viewpoints on this contentious issue. As a practicing clinician, be reassured that you will be given holistic yet concise accounts on what you will or may be faced with from conditions like perinatal stroke to demyelinating
conditions and from methods of intracranial pressure measurement to troubleshooting of intrathecal baclofen pumps. There is an excellent chapter on acute pain outlining different pathophysiological types of pain, pharmacology of commonly used analgesics and complementary treatment methods. Interestingly, this book is not only on ‘emergency neurology’ but also, and rather helpfully and indeed efficiently, covers conditions that might be seen in outpatient settings. The expertly-written chapter on ‘spasticity, dystonia and other movement disorders’ is a testimony to this. Having read this book, I came to conclude that it is full of rich knowledge and has plenty of wisdom pearls and an abundance of real life pragmatism. For those who would appreciate embarking on a joyful educational and possibly practice-changing (in one way or another) journey, I would urge you to either have this book or recommend it to your librarian as I did! Mohamed O.E. Babiker Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Yorkhill, G3 8SJ Glasgow, UK E-mail address: [email protected] 1090-3798/$ e see front matter http://dx.doi.org/10.1016/j.ejpn.2014.03.008
Official Journal of the European Paediatric Neurology Society
Book review Acute Pediatric Neurology, Thomas Sejersen, Ching H. Wang (Eds.). Springer-Verlag, London (2014). 405 pp., Hardcover V149.79, eBook V118.99, ISBN: 978-0-85729-490-6 (Print), ISBN: 978-0-85729-491-3 (Online).
Front line paediatricians, whether working in emergency departments, acute admissions, intensive care units or neurology on-calls, are not uncommonly faced with children with difficult to-diagnose and/or to-treat neurological disorders. Recognizing acute neurological presentations in children, stroke for instance, can be challenging leading at times, sadly, to either improper investigations or undertreatment.
Most current standard child neurology textbooks will contain topics on ‘acute’ or ‘emergency’ neurology; yet in a rather ‘textbook style’ or perhaps in a somewhat a ‘laboratory based escientist’s approach’, dare I say! Thus, a book that provides an authoritative, insightful, practical and concise clinical guide to hopefully overcome some of these challenges will be genuinely welcome. “Acute Pediatric Neurology” is probably here to serve this very purpose, one can safely claim. The book is divided into two parts. A symptom-oriented overview is presented in Part I detailing the important pathophysiological and clinical issues to be addressed when such symptoms are encountered. Part II, which spreads over 12 chapters, covers the management of acute neurological problems in an elegantly logical manner. Most chapters, if not all of them, are likeable and present the reader with a workable and down-to-earth problem-solving approach with a well-regarded emphasis on applying bedside clinical skills. For example, the chapter on acute disturbance of vision comes very handy to those of us who are not neuroophthalmologists but still find themselves having to figure out what is wrong with the child’s eyes who is seen during an outof-hours shift. Chapters on management are comprehensive and encompass wide areas. A good example is the chapter on status epilepticus where the authors take you from prehospital management through to the emergency department assessment and treatment algorithms and go beyond that to available treatment options for refractory cases such as immunotherapy, the ketogenic diet, surgery and so forth. That said, the chapter on the management of headaches focused, and rightly so, on the commoner forms of primary headaches; however it is a bit disappointing that other rare causes such as the trigeminal autonomic cephalalgias for example, are not covered. CNS infections, or the constant worries about them shall I say, are considered and empirically treated in many children with acute neurological presentations. A succinct account is given in this book covering a wide range of pathogens being it bacteria, viruses or even parasites such as plasmodium falciparum. Antimicrobial choices (or even their unproven benefit) and dosages are conveniently described although the authors have opted not to touch upon the ongoing controversy of steroids use. A slight criticism is the lack of mentioning of the so-called ‘para-infectious encephalopathies’ that are associated with common paediatric infections such as rotavirus and influenza. Another deficiency that the book suffers from is perhaps a section or two on the emerging important group of autoimmune encephalitides, the early recognition and aggressive treatment of which have been shown to improve outcomes.
2
e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y x x x ( 2 0 1 4 ) 1 e2
It is quite satisfying to see sections dedicated to the management of acute neuromuscular presentations such as myasthenic crisis, malignant hyperthermia and the periodic paralysis syndromes to name a few. Most readers will be delighted to see a whole chapter devoted to stroke and cerebrovascular diseases detailing the important tools that would aid the clinician to make a timely diagnosis and to put in motion management strategies. This chapter is written in a helpful ‘what-to- (and not to)-do’ style based on the currently available international evidence-based guidelines. The role of different neuroimaging modalities in different scenarios is cleverly described. With few exceptions, most chapters lack illustrative figures and diagrams, which could have arguably enhanced the educational value of the text immensely. However, there are still plenty of tables and ‘key points’ boxes that readers would find useful. One has to say that there is some inconsistency between some of the information given in some chapters. For instance, different cut off values for CSF opening pressure to diagnose paediatric idiopathic intracranial hypertension are described. Yet this might perhaps be a reflection of different authors’ viewpoints on this contentious issue. As a practicing clinician, be reassured that you will be given holistic yet concise accounts on what you will or may be faced with from conditions like perinatal stroke to demyelinating
conditions and from methods of intracranial pressure measurement to troubleshooting of intrathecal baclofen pumps. There is an excellent chapter on acute pain outlining different pathophysiological types of pain, pharmacology of commonly used analgesics and complementary treatment methods. Interestingly, this book is not only on ‘emergency neurology’ but also, and rather helpfully and indeed efficiently, covers conditions that might be seen in outpatient settings. The expertly-written chapter on ‘spasticity, dystonia and other movement disorders’ is a testimony to this. Having read this book, I came to conclude that it is full of rich knowledge and has plenty of wisdom pearls and an abundance of real life pragmatism. For those who would appreciate embarking on a joyful educational and possibly practice-changing (in one way or another) journey, I would urge you to either have this book or recommend it to your librarian as I did! Mohamed O.E. Babiker Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Yorkhill, G3 8SJ Glasgow, UK E-mail address: [email protected] 1090-3798/$ e see front matter http://dx.doi.org/10.1016/j.ejpn.2014.03.008