BOOK REVIEWS

Critical Care Neurology

By David H. Miller and Eric C. RapsButterworth-Heinemann, 1999

Critical Care Neurology meets its objective of beinga practical neurology reference book in that itprovides a handy, mostly concise, and accuratesource of information on the current managementof frequent intensive care neurologic problems.Each chapter and section provides a review ofappropriate anatomy and physiology and a succinctbut inclusive analysis of pertinent research tosupport the conclusions and discussion for eachof the major neurologic conditions that a clinician islikely to encounter in the intensive care unit forum.

The book starts with a thorough introduction onappropriate anatomy and physiology of respiration,and frequent intensive care presentations of respir-atory dysfunction in various neurologic disorders.This information is complemented by chapter 11, inwhich a different perspective and a more detailedaccount of anatomic localization as a cause ofchronic respiratory failure is discussed.

The rest of the book can be divided into three majorparts.Thefirstpart focusesonspecificdiagnoses, suchasGuillain–Barre syndrome, myasthenia gravis, con-vulsiveandnonconvulsivestatusepilepticus, throm-bosisof thecerebralveinsandsinuses, subarachnoidhemorrhage, and central nervous system infections.For the most part the chapters in this section sharerecent references and critical evaluationof pertinentstudies. Well-organized tables and illustrationsaccompany the text and a logical sequence ofappropriate and detailed steps are provided whichassist the reader in retaining pertinent informationregarding diagnosis and treatment of patients withthesevarious conditions.Asdemandedby the times,a chapter on current management of acute ischemicstroke is included in which a concise review of therecent stroke trials and state-of-the-art imagingillustrations are provided and discussed. Thischapter is particularly noteworthy because specificsigns and symptoms of clinical importance, alongwith their management, including the need for andtiming of thrombolytics, are addressed.

The second major part of the book deals witheither syndromes or central nervous system condi-tions of a wider etiology. Topics covered includeother causes of acute weakness in the intensive careunit; coma, vegetative state, and locked-in syn-drome; thrombotic and vasculitic disorders thataffect the central nervous system; and centralnervous system complications of critical medicalillness. These chapters also share didactic tables,complete with usual electrodiagnostic findings insome instances, which are instrumental in thediagnosis and examination of the weak, comatose,or critically ill patient. However, their value is

strengthened by the corresponding strategy out-lined in the text on how to approach patients withthese conditions. The reader is thus better equippedto arrive at a differential diagnosis and construct aplan for further diagnostic evaluation. The chapterdiscussing thrombotic and vasculitic disorders thataffect the central nervous system exemplifies howthis text assists the reader in clinical decision mak-ing, suggesting careful, but guided investigationalrationale within a limited list of possibilities. This isan invaluable resource when one is facing such acomplex patient with neurologic deterioration.

The chapter addressing pediatric neurologiccritical care stands alone as the third major part ofthe book. It outlines problems unique to thepediatric patient in the intensive care unit, includingthose seen in the premature infant. The chapter alsoincludes frequently encountered diagnoses, intra-cerebral pressure monitoring, treatment options,and even a brief discussion on predicting outcomein this patient population.

We thoroughly recommend this book to the neu-rologist and neurosurgeon in training, as well asneurologists, neurosurgeons, anesthesiologists, andotherintensivistswhocareforneurologicallycriticallyill patients. In addition, it can serve as a practical re-source inanyintensivecareunitbecauseof itsclarity,organization,accuracy,andpatientcareorientation.

Oscar A. Sanchez, MD andMuhammad Ramzan, MDNeurology DivisionUniversity of Massachusetts School of MedicineWorcester, MA

Surgery of the Aorta and its Branches

By Bruce L. Gewertz, MD andLewis B. Schwartz, MD, W.B. Saunders, Co., 2000

The improvement in outcome after surgery forpathology of the aorta and its major branchesremains a notable example of how developmentsin surgical technique are closely wed to advance-ments in intraoperative monitoring and postop-erative care. Pioneers in each of these arenas laidthe foundation for a contemporary morbidity andmortality of less than 5%, of which the largemajority of patients undergoing surgery areelderly and have multiple medical problems. Inan effort to ‘‘bring it all together,’’ editorsGewertz and Schwartz present a comprehensivetextbook outlining many of the important issuesthat have led to the current standard of care.Ironically the advent of minimally invasive endo-luminal grafting for the treatment of infrarenalabdominal aortic aneurysm has disrupted thisstandard of care. Recovery after endoluminalrepair, often occurring within 1 week, is withoutthe assistance of the intensive care unit during a2- to 3-day hospitalization.

Copyright Ó 2002 Blackwell Publishing, Inc. 53