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R A C Hughes, editor. (£35.00). BMJ Books, 2001. ISBN 0-7279-1405-7.
Neurological emergencies are comparatively rare but can have disastrous consequences if missed or mismanaged. Neurology terrifies many SHOs and even the most experienced A&E specialist is likely to feel nervous at the thought of a patient with myasthenic crisis or cerebral malaria. A text providing up to date, practical information on the diagnosis and immediate management of acute neurological emergencies would therefore be a useful addition to any emergency department library.
This book covers all the neurological emergencies likely to present to the emergency department. The pathophysiology of each condition is described in detail in each chapter, although the sections on acute management are often shorter and vaguer than I would like. The chapters on traumatic brain injury and tonic-clonic status epilepticus are particularly good and obviously written by clinicians used to managing acute patients. Similarly, the chapters on acute visual loss, acute behavioural disturbances, cerebral infection, and raised intracranial pressure are all interesting and contain useful information on differential diagnosis and treatment. However, the chapter on acute spinal cord compression suffers from having too much detail on different surgical procedures and not enough on immediate assessment and management. Additionally, the first chapter on medical coma is, to be blunt, poor. I suspect that while its author may be an eminent neurologist, it is a long time since they saw an acute patient. A lot of the information, especially on poisoning, is outdated and some of the management recommendations are rather suspect.
I was disappointed that apart from the chapters on traumatic brain injury and acute stroke, the other chapters are practically word for word the same as in the second edition. The cover of the book promises it “has been thoroughly revised and updated . . .” however there is not enough evidence of this to make it worth buying the third edition if you already have the second edition.
Despite the above criticisms, overall the book is interesting, and the contributions well written. It is a useful, concise reference text to have in the department and is particularly good for preparing teaching sessions or revising for the MRCS (A&E) or FFAEM exam as all the necessary information about pathophysiology, differential diagnosis, and investigation is there. I would recommend it to A&E specialists to be read at their leisure. However, it is not a practical handbook and not something you would consult when faced with an acutely sick patient.