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Introduction to Clinical Neurology, 2nd editionDouglas J. Gelb, May 2000, 416 pages, Butterworth Heinemann: London. ISBN 0750672021, £22.50
Neuromuscular Disorders 11 (2001) 760–763 www.elsevier.com/locate/nmd
Book reviews Handbook of Sleep Medicine J. Shneerson, March 2000, 256 pages, 56 illustrations, hardback, Blackwell Science, Oxford. ISBN: 0 632 05135 3, £49.50
This is the best of the recent crop of volumes on sleep and its disorders. As its title implies, this is a handbook rather than a conventional textbook and sets out to give the interested clinician practical advice and guidance on the diagnosis, investigation and management of sleep disorders. Chapters are set out in a clear, logical order with helpful diagrams, lists and illustrations and conclude with suggestions for further reading for those wishing to delve deeper. A good understanding of the physiological basis of normal and abnormal sleep is essential to sound management but is, sadly, rarely taught in medical schools or required in the syllabi of professional examinations. The opening chapters provide a clear and succinct remedy to this deficit. Assessment and investigation is covered in some depth as, again, most clinicians have not been adequately trained in the taking of a sleep history or in the appropriate use of the various investigatory tools. Subsequent chapters cover the various disorders of sleep, including insomnia, excessive daytime sleepiness, behavioural abnormalities and ‘Experiences, autonomic and immunological disorders in sleep’. This latter chapter, despite its somewhat daunting title, should be compulsory reading for all clinicians as it covers the sleep-related phenomena of a wide range of medical conditions from asthma to systemic mastotcytosis via gastro-oesophageai reflex and nocturia. The closing chapters summarise the respiratory disorders of sleep, respiratory pump problems, often secondary to neuromuscular disorders, and obstructive sleep apnoea. The former chapter provides an excellent practical approach based upon a clear exposition of the underlying pathophysiology. Detailed information on ventilatory management is, quite reasonably, not given, but the reader should feel confident in assessing such cases and making an appropriate referral to a specialist centre. This book can be recommended to all clinicians who may meet patients with sleep disorders in their clinical practice. As there are few branches of medicine where this is not so, it should find a place in all hospital and departmental libraries and may be commended to candidates for the MRCP, parti-
cularly to those who evince an interest in neurology and respiratory medicine. C.D. Hanning Sleep Disorders Service, Leicester General Hospital, Leicester, LE5 4PW, UK PII: S0 960-8966(00 )00 211-X
Introduction to Clinical Neurology, 2nd edition Douglas J. Gelb, May 2000, 416 pages, Butterworth Heinemann: London. ISBN 0750672021, £22.50 This updated second edition is an ideal introduction to clinical neurology. It is primarily aimed at medical students and general physicians, and also contains a few useful tips for the junior neurologist in training. The emphasis remains to provide a ‘systematic approach to the neurologic problems likely to be encountered in general medical practice’ and to focus on the practical issues of patient management. The text is divided into sections dealing with ‘Common Diseases ’: stroke, dementia, movement disorders, etc. and ‘Common Symptoms’: headache, dizziness and disequilibrium, etc. providing both a disease-centred and symptom-centred approach. This edition also includes a new section on the basic techniques of neurological examination and updates on new medical and surgical treatments e.g. rtPA, Clopidogrel, endarterectomy, COMT inhibitors and the surgical management of Parkinson’s disease. This book has a refreshing style. Each chapter begins with a set of clinical cases and associated questions. These focus the reader’s mind on the various modes of disease presentation. The author then clarifies important differentiating points in the history and on examination before proceeding to the differential diagnosis. This case-orientated style brings the text to life and makes it more relevant to the practising physician. It also makes it more memorable! The text is deliberately not comprehensive but covers all the common neurological diseases likely to be encountered in general medical practice and also gives a framework for understanding the more difficult or rare conditions. Many medical students and physicians struggle to achieve any confidence in neurology, daunted by the apparent mystery shrouding the subject. This book dispels these myths and presents a simple path to accurate neurological diagnosis. The style is
0960-8966/01/$ - see front matter q 2001 Elsevier Science B.V. All rights reserved.
C.D. Hanning / Neuromuscular Disorders 11 (2001) 760–763
light, clear and concise (which is unusual for a neurology text) and most of all it makes neurology fun to read.
Philip Nichols Department of Clinical Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
761
should one add cyclophosphamide to corticosteroids or wait a little longer ? This is a very critical issue since true isolated CNS angiitis is a severe condition almost invariably leading to death if not properly treated. By contrast, ‘reversible segmental cerebral angiopathy’ is by definition a spontaneously reversible disorder, for which one would like to avoid performing a brain biopsy. Apart from this (minor) criticism, this is an excellent book that should be extremely useful to both neurologists and internists.
PII: S 0960-896 6(00)00212-1
Central Nervous System Angiitis James W. Schmidley, April 2000, 240 pages, hardback, Heinemann Publishers, Oxford. ISBN: 0 7506 7153, £70.00
Marie-Germaine Bousser Hoˆ pital Lariboisie`re Service de Neurologie 2, rue Ambroise Pare´ 75475 – Paris ce´ dex 10 France PII: S0960 -8 966(00)00213 -3
James W. Schmidley has written an excellent book on a very difficult topic. Indeed, the literature on central nervous system (CNS) angiitis is highly confusing for two main reasons. Firstly, numerous cases have been reported in which the diagnosis was based purely on angiographic findings. Secondly, in many systemic conditions (inflammatory or infectious diseases for example) with CNS involvement, there is a frequent confusion between true angiitis and other pathogenic mechanisms. The author has done a remarkable job in clarifying these two issues. He gives an excellent description of both ‘true’ isolated CNS angiitis (that is, histologically proven) and of secondary angiitis, such as those associated with lymphoma, sarcoidosis, giant cell arteritis, amyloid angiopathy, systemic vasculitis, other inflammatory and connective tissue disorders, infectious diseases and drug abuse. All of these conditions are appropriately reviewed with numerous references. My only regret is that, given the rarity of these conditions, and the wide experience of the author, he does not address some very practical and difficult issues such as the detailed work up that should be done to rule out secondary angiitis and the optimal timing of biopsy. It is not infrequently that neurologists are faced with patients presenting with neurological symptoms, angiographic abnormalities and CSF findings compatible with the diagnosis of isolated CNS angiitis. However, as rightly stressed by the author, the same abnormal findings can occur in disorders such as ‘reversible segmental cerebral angiopathy’. This syndrome is well described but the crucial practical issue of the timing of biopsy is not discussed. If the patient does not rapidly improve spontaneously, the author favours a short course of glucocorticoids, but how this treatment might affect the later histological diagnosis of a true angiitis is not discussed. If the patient is stable with steroids, how long should one wait before performing the brain and leptomeningeal biopsy? Furthermore, what should be done if the biopsy is negative:
Management Of Persons With Chronic Neurologic Illness Ozer, Mark.352 pp, 254 £ 178 mm: 15 line illustrations: Butterworth, Heinemann, Hardcover: March 2000 £45 ISBN 0 7506 7005 3 Another new text on the management of neurological disability confirms that neurorehabilitation has come of age and is now of interest to both specialist and general physicians. This book will be of most interest to the nonspecialist or student. It attempts to bridge the gap between general and specialist rehabilitation texts. This is not an easy task and sometimes leads to an imbalance creeping in with a lucid clinical description of a disease process marred by a clumsy exposition of the chosen rehabilitation framework. The first three chapters are on theories of rehabilitation and the remaining nine are on disease processes. The reader may get the feeling it is Groundhog Day as he finds each clinical chapter finishing with a similar treatise on measurement but there are thankfully some variations. The book is worth reading for the emphasis it places on patient participation in the rehabilitation process and for the concept that rehabilitation is a continuing activity, not limited to location in a rehabilitation unit. Mark Ozer introduces the use of a participation scale. If this works, it gradually enables the patient to initiate and continue goal orientated rehabilitation after discharge. This is reinforced by introducing a self-management programme in which the patient is encouraged to identify the successful elements of his rehabilitation programme, and record them as ‘What works’. In this way the patient learns and takes responsibility for the rehabilitation cycle of assessment, goal planning, implementation and review. Dr Ozer suggests that the rehabilitation experience of his
Book reviews Handbook of Sleep Medicine J. Shneerson, March 2000, 256 pages, 56 illustrations, hardback, Blackwell Science, Oxford. ISBN: 0 632 05135 3, £49.50
This is the best of the recent crop of volumes on sleep and its disorders. As its title implies, this is a handbook rather than a conventional textbook and sets out to give the interested clinician practical advice and guidance on the diagnosis, investigation and management of sleep disorders. Chapters are set out in a clear, logical order with helpful diagrams, lists and illustrations and conclude with suggestions for further reading for those wishing to delve deeper. A good understanding of the physiological basis of normal and abnormal sleep is essential to sound management but is, sadly, rarely taught in medical schools or required in the syllabi of professional examinations. The opening chapters provide a clear and succinct remedy to this deficit. Assessment and investigation is covered in some depth as, again, most clinicians have not been adequately trained in the taking of a sleep history or in the appropriate use of the various investigatory tools. Subsequent chapters cover the various disorders of sleep, including insomnia, excessive daytime sleepiness, behavioural abnormalities and ‘Experiences, autonomic and immunological disorders in sleep’. This latter chapter, despite its somewhat daunting title, should be compulsory reading for all clinicians as it covers the sleep-related phenomena of a wide range of medical conditions from asthma to systemic mastotcytosis via gastro-oesophageai reflex and nocturia. The closing chapters summarise the respiratory disorders of sleep, respiratory pump problems, often secondary to neuromuscular disorders, and obstructive sleep apnoea. The former chapter provides an excellent practical approach based upon a clear exposition of the underlying pathophysiology. Detailed information on ventilatory management is, quite reasonably, not given, but the reader should feel confident in assessing such cases and making an appropriate referral to a specialist centre. This book can be recommended to all clinicians who may meet patients with sleep disorders in their clinical practice. As there are few branches of medicine where this is not so, it should find a place in all hospital and departmental libraries and may be commended to candidates for the MRCP, parti-
cularly to those who evince an interest in neurology and respiratory medicine. C.D. Hanning Sleep Disorders Service, Leicester General Hospital, Leicester, LE5 4PW, UK PII: S0 960-8966(00 )00 211-X
Introduction to Clinical Neurology, 2nd edition Douglas J. Gelb, May 2000, 416 pages, Butterworth Heinemann: London. ISBN 0750672021, £22.50 This updated second edition is an ideal introduction to clinical neurology. It is primarily aimed at medical students and general physicians, and also contains a few useful tips for the junior neurologist in training. The emphasis remains to provide a ‘systematic approach to the neurologic problems likely to be encountered in general medical practice’ and to focus on the practical issues of patient management. The text is divided into sections dealing with ‘Common Diseases ’: stroke, dementia, movement disorders, etc. and ‘Common Symptoms’: headache, dizziness and disequilibrium, etc. providing both a disease-centred and symptom-centred approach. This edition also includes a new section on the basic techniques of neurological examination and updates on new medical and surgical treatments e.g. rtPA, Clopidogrel, endarterectomy, COMT inhibitors and the surgical management of Parkinson’s disease. This book has a refreshing style. Each chapter begins with a set of clinical cases and associated questions. These focus the reader’s mind on the various modes of disease presentation. The author then clarifies important differentiating points in the history and on examination before proceeding to the differential diagnosis. This case-orientated style brings the text to life and makes it more relevant to the practising physician. It also makes it more memorable! The text is deliberately not comprehensive but covers all the common neurological diseases likely to be encountered in general medical practice and also gives a framework for understanding the more difficult or rare conditions. Many medical students and physicians struggle to achieve any confidence in neurology, daunted by the apparent mystery shrouding the subject. This book dispels these myths and presents a simple path to accurate neurological diagnosis. The style is
0960-8966/01/$ - see front matter q 2001 Elsevier Science B.V. All rights reserved.
C.D. Hanning / Neuromuscular Disorders 11 (2001) 760–763
light, clear and concise (which is unusual for a neurology text) and most of all it makes neurology fun to read.
Philip Nichols Department of Clinical Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
761
should one add cyclophosphamide to corticosteroids or wait a little longer ? This is a very critical issue since true isolated CNS angiitis is a severe condition almost invariably leading to death if not properly treated. By contrast, ‘reversible segmental cerebral angiopathy’ is by definition a spontaneously reversible disorder, for which one would like to avoid performing a brain biopsy. Apart from this (minor) criticism, this is an excellent book that should be extremely useful to both neurologists and internists.
PII: S 0960-896 6(00)00212-1
Central Nervous System Angiitis James W. Schmidley, April 2000, 240 pages, hardback, Heinemann Publishers, Oxford. ISBN: 0 7506 7153, £70.00
Marie-Germaine Bousser Hoˆ pital Lariboisie`re Service de Neurologie 2, rue Ambroise Pare´ 75475 – Paris ce´ dex 10 France PII: S0960 -8 966(00)00213 -3
James W. Schmidley has written an excellent book on a very difficult topic. Indeed, the literature on central nervous system (CNS) angiitis is highly confusing for two main reasons. Firstly, numerous cases have been reported in which the diagnosis was based purely on angiographic findings. Secondly, in many systemic conditions (inflammatory or infectious diseases for example) with CNS involvement, there is a frequent confusion between true angiitis and other pathogenic mechanisms. The author has done a remarkable job in clarifying these two issues. He gives an excellent description of both ‘true’ isolated CNS angiitis (that is, histologically proven) and of secondary angiitis, such as those associated with lymphoma, sarcoidosis, giant cell arteritis, amyloid angiopathy, systemic vasculitis, other inflammatory and connective tissue disorders, infectious diseases and drug abuse. All of these conditions are appropriately reviewed with numerous references. My only regret is that, given the rarity of these conditions, and the wide experience of the author, he does not address some very practical and difficult issues such as the detailed work up that should be done to rule out secondary angiitis and the optimal timing of biopsy. It is not infrequently that neurologists are faced with patients presenting with neurological symptoms, angiographic abnormalities and CSF findings compatible with the diagnosis of isolated CNS angiitis. However, as rightly stressed by the author, the same abnormal findings can occur in disorders such as ‘reversible segmental cerebral angiopathy’. This syndrome is well described but the crucial practical issue of the timing of biopsy is not discussed. If the patient does not rapidly improve spontaneously, the author favours a short course of glucocorticoids, but how this treatment might affect the later histological diagnosis of a true angiitis is not discussed. If the patient is stable with steroids, how long should one wait before performing the brain and leptomeningeal biopsy? Furthermore, what should be done if the biopsy is negative:
Management Of Persons With Chronic Neurologic Illness Ozer, Mark.352 pp, 254 £ 178 mm: 15 line illustrations: Butterworth, Heinemann, Hardcover: March 2000 £45 ISBN 0 7506 7005 3 Another new text on the management of neurological disability confirms that neurorehabilitation has come of age and is now of interest to both specialist and general physicians. This book will be of most interest to the nonspecialist or student. It attempts to bridge the gap between general and specialist rehabilitation texts. This is not an easy task and sometimes leads to an imbalance creeping in with a lucid clinical description of a disease process marred by a clumsy exposition of the chosen rehabilitation framework. The first three chapters are on theories of rehabilitation and the remaining nine are on disease processes. The reader may get the feeling it is Groundhog Day as he finds each clinical chapter finishing with a similar treatise on measurement but there are thankfully some variations. The book is worth reading for the emphasis it places on patient participation in the rehabilitation process and for the concept that rehabilitation is a continuing activity, not limited to location in a rehabilitation unit. Mark Ozer introduces the use of a participation scale. If this works, it gradually enables the patient to initiate and continue goal orientated rehabilitation after discharge. This is reinforced by introducing a self-management programme in which the patient is encouraged to identify the successful elements of his rehabilitation programme, and record them as ‘What works’. In this way the patient learns and takes responsibility for the rehabilitation cycle of assessment, goal planning, implementation and review. Dr Ozer suggests that the rehabilitation experience of his