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Cerebrovascular disorders ed 4 By James F. Toole MD New York Raven Press 1990 567 pages illustrated $95

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BOOKS
Entrapment Neuropathies, ed 2
By David M . Dawson, M D , Mark Hallett, M D ,
and Lewis H . Millender, M D
Boston, Little. Brown, 1990
464 pp, illustrated, $69.50
This is an excellent book that will interest neurologists and
others who care for patients with neuropathies. The approach
is syndrome-oriented, providing concise but detailed reviews
of the anatomy and clinical features of focal peripheral neuropathies. Common disorders are emphasized, such as median neuropathy at the wrist, but uncommon conditions also
are considered. There are interesting new sections on sportsrelated injuries, iatrogenic and occupational neuropathies,
and focal disorders of musicians. Presentations are complete,
clinical pearls abound, and references are well chosen.
This volume is unique in that it is written jointly by neurologists and an orthopedic surgeon. As a result the view is
more balanced than that found in competing books written
only from a neurologic or a surgical perspective. Nevertheless, too much space is devoted to surgical details, and not
enough to providing the specific diagnostic and therapeutic
guidelines that will be sought by the clinicians who will turn
to this book. There are many fine photographs, but a number
are redundant and some figures are not of high quality. The
book‘s organization is at times inconsistent. For example, although differential diagnosis and peripheral electrophysiology are treated in individual chapters, similar material is presented along with discussions of some individual syndromes.
One hopes that the authors will continue to capitalize on
their singular cooperative effort in future editions. I would
especially like to see more critical explorations of the controversial questions for which neurologists and nerve surgeons
often have different answers. To suggest several: Why d o
some say that thoracic outlet syndrome is rare while others
report a thousand cases? Is “EMG-negative” entrapment neuropathy a reflection of insensitive electrodiagnosis or flawed
diagnostic criteria? Which features distinguish neuritic pain
from causalgia?
Mark J . Rrown, M D
Clinical Neurophysiology Updates, Volume 1:
Neuromonitoring in Surgery
Edited by,J. E. Desmedt, M D
Amsterdam, Elsevier. 1989
377 pp. illustrated, $155.25
In 20 chapters this monograph describes a variety of state-ofthe-art monitoring techniques used during surgical intervention on the brain, brainstem, spine, spinal cord, spinal roots,
plexus, and peripheral nerves. The three most important
evoked potential techniques used in neuromonitoring are the
somatosensory, brainstem auditory, and motor evoked potentials, and these are masterfully described in the first five
chapters. Spinal cord monitoring employing both somatosensory evoked potential techniques and direct spinal cord or
motor cortical stimulation is an important recent advance
used to evaluate postoperative neurological dysfunction after
spine surgery, and the technique is described adequately in
four chapters.
The role of neurophysiological monitoring in certain situations, eg., spinal surgery; posterior fossa surgery, particularly
for acoustic neuroma and neurovascular compression; and
peripheral nerve surgery has been well established. In procedures involving brainstem and intracranial surgery, however,
the role of the evoked potential techniques in intraoperative
monitoring remains uncertain. These procedures are discussed in various chapters. It is also important to remember
that occasionally false negative results occur, e.g., normal
evoked potential response in the presence of impaired neural
function postoperatively. There are many pitfalls, and safety
and other special precautions that should be undertaken during neuromonitoring in an environment that is not conducive
to neuromonitoring procedures. All these have been discussed adequately in various chapters. The monograph concludes by describing briefly extraoperative monitoring of
patients with intractable seizures and monitoring during electrode implantation for relief of chronic pain. The final chapter
deals with evoked potential monitoring in interventional
neuroradiology; in the opinion of this reviewer its role remains highly controversial in this field.
An important problem during monitoring is to decide
which characteristics (e.g., latency, amplitude, morphology)
of the evoked potential response significantly correlate with
the postoperative neural functions and therefore it is essential
that a standardized procedure be used. The Mayo Clinic protocols dealing with monitoring of cranial and peripheral
nerves and monitoring with evoked potentds provide excellent practical suggestions.
This volume summarizes the latest advances in the field of
neuromonitoring in surgery in a clear fashion and shouId
be particularly useful to those dealing with intraoperative
neurophysiological monitoring.
Sudbansu Cbokriivwty. h f D
Cerebrovascular Disorders, ed 4
By James F . Taole, M D
New York, Raven Press. 1990
567 pages, illustrated, $95.00
Some things, like good wines, improve and mellow with age.
The fourth edition of Cerebrovascular Disorders by James
Toole is better and more comprehensive than its predecessors. The first edition appeared in 1767 and the previous
version was published in 1783.This book is by far the longest
continuously running show in the field and the only monograph written entirely by one individual. Toole is one of the
senior investigators and statesman in the field of stroke. His
broad experience in the care of stroke patients and his personal familiarity with all aspects of stroke are evident on
every page.
The book has some excellent features. The importance of
stroke to society in general and its effect on important historical figures are emphasized. The organization of both the book
and each individual chapter facilitates the use of the book for
quick reference. Bold headings subdivide each chapter. The
references at the end of each chapter are up to date and are
listed alphabetically, grouped under specific topics covered
in that chapter. For example, in the chapter on inflammatory
angiopathies, separate reference lists are given for Takayasu’s
Annals of Neurology
Vol 30 No 5
November 1771 739
arteritis, giant cell arteritis, polyarteritis nodosa, and Wegener’s granulomatosis. Topics at the interface between stroke
and general medicine, such as atherosclerosis, hypertension,
and migraine, are covered more generally and in more depth
than in other stroke texts. The writing is consistent, direct,
and clear. The figures and diagrams are well chosen to illustrate and reinforce the text. The volume is up to date on
current topics such as transcranial Doppler ultrasound, magnetic resonance imaging and magnetic resonance angiography, and thrombolytic treatment with recombinant tissue
plasminogen activator. Some topics discussed, such as living
wills and driving after stroke, are usually not covered in other
stroke texts.
There are some features that are less attractive. I prefer to
find references also cited in the text. I learned for the first
time that blood transit was slower in the posterior circulation
than in the anterior, that the average internal diameter of the
internal carotid artery at the sinus was 7 mm, and that there
was a published case of transient global amnesia with reversible MRI abnormalities in the medial temporal lobe. Alas,
without citations, I could not locate the data source for more
detail. Some studies and authors are referred to in the text
but not referenced at the end of the chapter. Some statements I believe are in error: the anterior cerebral artery does
not supply the frontal eye field, Brodman area 8 (p 84);
thalamogeniculate artery territory infarcts do not have a
hemianopia (p 118);patients with intracerebral hemorrhage
do not require two weeks of bed rest (p 376); ergots should
not be the mainstay of migraine treatment, especially in
stroke patients (p 446). There are a few typographical and
syntactical errors. Cardiac decompensation is meant instead
of cardiac decompression (p 138), and venous, not arterial,
DSA is being abandoned (p 193).
Coverage and space allotted to topics are spotty and idiosyncratic. Takayasu’s arteritis and fibromuscular d ysplasia
each occupy three full pages of text whereas cerebral events
after cardiac surgery are covered in less than one page. Other
subjects given too brief attention are lateral medullary syndrome (four paragraphs), putaminal hemorrhage (one paragraph), and cerebellar infarction (two paragraphs). References are given for Behcet’s syndrome but the topic is not
discussed. Childhood stroke is not covered. Some topics are
discussed in a number of different chapters, e.g., carotid artery disease and carotid surgery. Organization is odd. Intracerebral hemorrhage (ICH) is discussed in Chapter 18 but subarachnoid hemorrhage (SAH) is not covered until Chapter
23. Aneurysms and arteriovenous malformations are discussed in different and separate chapters, not in those on
ICH or SAH. Amyloid angiopathy is discussed under microcirculation, not in the hemorrhage chapters, and Binswanger’s disease is covered in the dementia chapter, not in
the chapter on hypertension and its complications.
The stated aim of the book is to help clinicians “who have
limited knowledge of the cerebral circulation and its diseases”
learn more about the subject. The book will serve this group
very well as a practical source for quick reference to a subject
and for sound and practical advice on the diagnosis and management of common conditions. The book differs substantially from its two major competitors. Stroke: Patbopbysiolog,
Diagnosis, and Management. edited by Barnett, Mohr, Stein,
and Yatsu, is a large, two-volume encyclopedic type of text
of interest mostly to workers in the field and others seeking
in-depth analysis of certain topics. Stroke: A Clinical Approach,
by Caplan and Stein, is a shorter volume meant to be read
cover to cover as aprimer to share an approach to the patient.
It liberally uses patient examples, covers some topics in less
depth, and is not as easily used for quick referencing as
Toole’s book. I recommend the fourth edition of Toole’s
CerebrovaJcular Disorders as an important and valuable reference source for all physicians who care for stroke patients.
Louis R. Capkan, M D
740 Annals of Neurology Vol 30 N o 5 November 1991
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cerebrovascular, york, 1990, illustrated, disorder, tool, 567, rave, pres, new, page, james
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