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Neurologic catastrophes in the emergency department.
  1. Susan M Robinson
  1. Accident and Emergency Department, Addenbrooke's Hospital, Cambridge

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    By E F M Wijdicks (Pp 266; £42.50). Butterworths Heinemann, 2000. ISBN 0-7506-7055-X.

    Neurology is not generally perceived as one of the more glamorous medical specialties. This textbook has an upbeat approach. In the preface, the author borrows the now ubiquitous “golden hour” concept for acute neurology.

    The text is said to be “brief to facilitate reading” and “is intended to reflect the train of thought and action in the emergency department”. Compared with the average neurological textbook it may be brief but it would not be recognised as such by most emergency physicians.

    The book is divided into two sections. The first covers conditions affecting the neuroaxis and the second, neurological disorders attributable to specific causes. Detailed descriptions of a number of neurological conditions and their aetiology are provided. The usual neurological emergencies are included, for example, status epilepticus and aneurysmal subarachnoid haemorrhage. In addition rather less obvious emergencies such as acute obstructive hydrocephalus and acute white matter disease are also discussed. The chapter on altered arousal and coma contains an exhaustive list of the major causes of coma, some of these conditions are unlikely to form part of a differential diagnosis formulated in the emergency department. However, the detail contained within the sections on examination of the patient in coma and the assessment of patients with acute unilateral masses reminded me of a number of long forgotten clinical signs. In many chapters there is a brief but detailed and informative review of anatomy and pathophysiology.

    Many of the investigations, for example, EEG, SPECT suggested in other chapters might be problematic to arrange in the average emergency department. “I want a SPECT stat”.

    In parts the clinical practice described does not follow current UK practice (or even standard clinical practice of 10 years ago). For example, it is implied that the administration of antibiotics in bacterial meningitis be delayed until CT/MRI and lumbar puncture have been performed.

    The book is unlikely to be used “acutely” on a daily or weekly basis. I suspect this book is akin to an interview suit, something to be dragged out on rare, special and stressful occasions. It will prove a useful reference book for those reviewing cases, those on a neurosciences secondment or doctors preparing for examination. What were those five causes of upgoing plantars and absent ankle jerks again?

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