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An atlas of structures, sections, and systems
430
Surg Neurol 1983;20:430
Book Reviews
A d v a n c e s in N e u r o l o g y , V o l u m e 34. S t a t u s Epilepticus: Mechanisms of Brain Damage and Treatment. A. V. Delgado-Escueta, C. G. Wasterlain, D. M. Treiman, and R. J. Porter, editors. 579 pp., $79.00. N e w Y o r k : R a v e n Press, 1982. The work at hand undertakes the large task of analyzing status epilepticus from three viewpoints: its clinical phenomenology; the various proposed mechanisms of inception, propagation, and resultant neuronal damage; and the several means of managing the crisis at the bedside. Of course, status epilepticus is but one, albeit dramatic, manifestation of the "falling evil," and coming to grips with it requires much of the clinical and experimental foundation of epileptology. A tall order indeed, and the 56 contributions by 106 investigators make this large volume dense with observations, correlations, and speculations. The opening section, "Electroclinical Correlations," attempts to standardize the nosology of status epilepticus based on etiology, age group, electroencephalographic analysis, clinical characteristics, and prognosis. Among the salient features emphasized is the frequency of nonconvulsive status epilepticus encountered in all age groups. Thus, complex partial, or "temporal lobe," status epilepticus in the adult patient, who may very well harbor a lesion in the frontal rather than the temporal lobes, has been recognized relatively recently. Moreover, neonatal status epilepticus in any of its rudimentary forms-subtle oral and ocular movements, apneic spells, or fragmentary clonic, tonic, or myclonic fits--must always be considered a matter of grave prognostic import for the developing brain. It is this latter issue of neuronal injury as a direct result of prolonged seizures, long suspected by some clinicians but only recently documented reliably and reproducibly by Aicardi and Chevrie in infants and by Brian Meldrum in adults, that constitutes the middle and largest section of the book, "Mechanisms of Brain Damage." It has now been amply demonstrated in human pathologic specimens and a host of animal models that prolonged seizure discharges per se are neurotoxic, even in paralyzed, anesthetized animal models in which optimal temperature, pH, glucose perfusion levels, and oxygenation are rigidly maintained; that is, electrical status epilepticus is bad for the brain. Specifically, it is bad for pyramidal neurons in the third lamina of the neocortex and Sommer's sector of the hippocampus, precisely the areas at risk in hypoxic, ischemic, and hypoglycemic insults. Why this is so has led various investigators to study stains from most of the vantage points of modern neurobiology: synchronized depolarization shifts and neuronal bursting; microregional circulation and metabolism; slow calcium currents and cytotoxicity; disruption of the macromolecular machinery of cell metabolism (disaggregation of polyribosomes and lipid-protein membranes); and regulation of transmitter receptors, especially those for y-aminobutyric
acid and the benzodiazepines. Taken together, these studies constitute a remarkably rich treatise on neuroscience. The book closes with a less intensive but more practical series of papers outlining the treatment of status epilepticus. Little is new here: diazepam and phenytoin are the standards, and barbiturates, paraldehyde, valproate, and general anesthesia the reserve in intractable situations. A fine volume indeed, but, alas, not one apt to find a large readership among subscribers to this journal. Perhaps those neurosurgeons with a large portion of their clinical work devoted to pediatrics or epileptic populations; however, I believe the proper audience will ultimately be found among neurologists, physiologists, and pharmacologists actively engaged in the study of the "falling evil." FRED EPSTEIN, M.D. Richmond, Virginia
An Atlas of Structures, Sections, and Systems. By D u a n e E. Haines. 212 pp., $19.50. Baltimore: U r b a n & Schwarzenberg, 1983. This superb atlas has unique features, which the eminent neuroanatomist Malcolm Carpenter points out in the foreword after his intensive review of the text. In Chapter 1, the author describes the rationale for his unique methods of presenting his material, all of which seem reasonable. In the book, gross sections are shown on one page, and the blood supply to those sections on the facing page. All abbreviations and numbers used are explained on the same or a facing page, so that the labeling of areas is never cluttered. The stained cross-sections of the brain and spinal cord are presented as hemisections, with the other half sections being a mirror image outlining and identifying the various tracts. Haines attempts a brief correlation of anatomy with roentgenograms and CT scans, but points out that a detailed correlation is impossible in a book of this type. This book will be useful to students of medicine as well as students of related disciplines for learning the anatomy of the central nervous system and its various tracts and associated pathways, and in reviewing this material in a very easy manner. It will be particularly useful to residents, and also to graduate physicians who need to have a quick and ready reference to anatomic detail. The atlas is printed on good paper with excellent reproductions, and, as Dr. Carpenter points out, is easy to follow. It is an outstanding guide to the structural organization of the central nervous system. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina
Surg Neurol 1983;20:430
Book Reviews
A d v a n c e s in N e u r o l o g y , V o l u m e 34. S t a t u s Epilepticus: Mechanisms of Brain Damage and Treatment. A. V. Delgado-Escueta, C. G. Wasterlain, D. M. Treiman, and R. J. Porter, editors. 579 pp., $79.00. N e w Y o r k : R a v e n Press, 1982. The work at hand undertakes the large task of analyzing status epilepticus from three viewpoints: its clinical phenomenology; the various proposed mechanisms of inception, propagation, and resultant neuronal damage; and the several means of managing the crisis at the bedside. Of course, status epilepticus is but one, albeit dramatic, manifestation of the "falling evil," and coming to grips with it requires much of the clinical and experimental foundation of epileptology. A tall order indeed, and the 56 contributions by 106 investigators make this large volume dense with observations, correlations, and speculations. The opening section, "Electroclinical Correlations," attempts to standardize the nosology of status epilepticus based on etiology, age group, electroencephalographic analysis, clinical characteristics, and prognosis. Among the salient features emphasized is the frequency of nonconvulsive status epilepticus encountered in all age groups. Thus, complex partial, or "temporal lobe," status epilepticus in the adult patient, who may very well harbor a lesion in the frontal rather than the temporal lobes, has been recognized relatively recently. Moreover, neonatal status epilepticus in any of its rudimentary forms-subtle oral and ocular movements, apneic spells, or fragmentary clonic, tonic, or myclonic fits--must always be considered a matter of grave prognostic import for the developing brain. It is this latter issue of neuronal injury as a direct result of prolonged seizures, long suspected by some clinicians but only recently documented reliably and reproducibly by Aicardi and Chevrie in infants and by Brian Meldrum in adults, that constitutes the middle and largest section of the book, "Mechanisms of Brain Damage." It has now been amply demonstrated in human pathologic specimens and a host of animal models that prolonged seizure discharges per se are neurotoxic, even in paralyzed, anesthetized animal models in which optimal temperature, pH, glucose perfusion levels, and oxygenation are rigidly maintained; that is, electrical status epilepticus is bad for the brain. Specifically, it is bad for pyramidal neurons in the third lamina of the neocortex and Sommer's sector of the hippocampus, precisely the areas at risk in hypoxic, ischemic, and hypoglycemic insults. Why this is so has led various investigators to study stains from most of the vantage points of modern neurobiology: synchronized depolarization shifts and neuronal bursting; microregional circulation and metabolism; slow calcium currents and cytotoxicity; disruption of the macromolecular machinery of cell metabolism (disaggregation of polyribosomes and lipid-protein membranes); and regulation of transmitter receptors, especially those for y-aminobutyric
acid and the benzodiazepines. Taken together, these studies constitute a remarkably rich treatise on neuroscience. The book closes with a less intensive but more practical series of papers outlining the treatment of status epilepticus. Little is new here: diazepam and phenytoin are the standards, and barbiturates, paraldehyde, valproate, and general anesthesia the reserve in intractable situations. A fine volume indeed, but, alas, not one apt to find a large readership among subscribers to this journal. Perhaps those neurosurgeons with a large portion of their clinical work devoted to pediatrics or epileptic populations; however, I believe the proper audience will ultimately be found among neurologists, physiologists, and pharmacologists actively engaged in the study of the "falling evil." FRED EPSTEIN, M.D. Richmond, Virginia
An Atlas of Structures, Sections, and Systems. By D u a n e E. Haines. 212 pp., $19.50. Baltimore: U r b a n & Schwarzenberg, 1983. This superb atlas has unique features, which the eminent neuroanatomist Malcolm Carpenter points out in the foreword after his intensive review of the text. In Chapter 1, the author describes the rationale for his unique methods of presenting his material, all of which seem reasonable. In the book, gross sections are shown on one page, and the blood supply to those sections on the facing page. All abbreviations and numbers used are explained on the same or a facing page, so that the labeling of areas is never cluttered. The stained cross-sections of the brain and spinal cord are presented as hemisections, with the other half sections being a mirror image outlining and identifying the various tracts. Haines attempts a brief correlation of anatomy with roentgenograms and CT scans, but points out that a detailed correlation is impossible in a book of this type. This book will be useful to students of medicine as well as students of related disciplines for learning the anatomy of the central nervous system and its various tracts and associated pathways, and in reviewing this material in a very easy manner. It will be particularly useful to residents, and also to graduate physicians who need to have a quick and ready reference to anatomic detail. The atlas is printed on good paper with excellent reproductions, and, as Dr. Carpenter points out, is easy to follow. It is an outstanding guide to the structural organization of the central nervous system. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina