Too often, handbooks designed to present a specific topic in a simple, understandable, and credible context fall short of expectations. That is certainly not the case with this excellently organized, well presented, and practical manual of what constitutes modern neurocritical care. The authors have managed to simplify a mountain of complex and often contentious technical information into a usable and practical resource manual that is timely and explicit in its detail.

The text begins with what one should do when confronted by a neurologically ill or injured patient while working in an outlying hospital or clinic. The correct course of action in the primary care setting is well described with the “Key Points” presented up front. These points are then followed by a concise explanation of why this is the proper pathway toward a safe and expedient transfer of the patient to the specialty hospital. The text is highly accurate and consistent with all of the current management guidelines put forth by the various professional neuroscience organizations. Because this volume is so well organized and concise in its presentation, it will be of great value as a teaching aid for critical care physicians, neurocritical care nurses, and allied health workers in the neuroscience fields.

This manual-sized textbook is full of meaningful figures, although a few are of a lesser quality, depicting the various neuro-imaging studies available to the practitioner.  The figures are well labeled with a clear explanation of the subject matter. Neuroradiologists will find this text of interest because it describes well the neuro-pathology responsible for the image abnormalities presented.  Multimodal monitoring of neurological function, used more and more in critical care due to the difficulty in interpreting single variables in neurological disease, is additionally presented and clearly explained in the text.

In summary, Neurocritical care: A Guide to Practical Management is a comprehensive well conceived and presented text. Concise and organized in a logical step-by-step fashion, it will provide the reader with a fundamental knowledge of acute neurological disease processes, a clearly defined plan of action for the physician with an explanation complimented with descriptive neuro-imaging, step-by-step charts, and well delineated graphs. More information is packed into this book than in other books three times the size. For a more detailed analysis of the subjects presented, a list of the top references for each subject is provided.

I recommend this book as a practical manual for anyone who may become involved in the care of acutely ill neurological patients, especially those working in emergency rooms and community hospitals. It is also a good resource book for physicians training to be neurologists, neurosurgeons, trauma specialists, intensivists, or interventionalists.

“I don’t know” is a phrase I use all too often when trying to address questions from my Radiology and Pediatric residents who ask me detailed questions about the evidence behind a radiological “call” and consequences of my diagnostic decisions. I say, “I don’t know” because I believe in giving answers based on evidence and not on anecdote. “Because that’s what I was taught” is a very unsatisfactory answer for me and our residents. I wish I had the time to master the evidence-base of all topics in pediatric imaging practice, but the option of taking multi-year sabbaticals for independent study is not feasible. This is why I enthusiastically picked up Evidence-Based Imaging in Pediatrics to provide some insight into these difficult questions.

The book opens up with some principles of evidence-based imaging and an assessment of the literature. I’ve amassed a collection of biostatistics and methods books to try and understand these topics and advise residents and other faculty on study design. The discussion of the evidence based process, Bayes theorem, and ROC curves was discussed briefly and is as good if not better than books devoted to biostatistics. The discussion on confidence interval, which actually takes less than a full page, is the clearest description of the topic I’ve read to date, finally makes sense and kept me awake, unlike most other treatises on the topic. These two chapters set the framework for the remainder of the manuscript.

The book is divided into 6 parts. Part 1: “Principles, Methodology, and Radiation Risk” describes principles of evidence-based imaging and delves into the evidence behind radiation risk in children. Part 2: “Neuroimaging is divided into 9 chapters.” Topics include Craniosynostosis, sickle cell disease and stroke, neonatal hypoxic ischemic encephalopathy, traumatic brain injury, neoplasms, headache, seizures, sinus disease and nonaccidental head injury. Part 3: “Musculoskeletal Imaging” is divided into 11 chapters and covers a variety of topics including non-accidental trauma, spine trauma, other spine disorders and dysraphisms, assessment of the peripheral joints, osteomyelitis and septic arthritis, bone tumors, knee and shoulder injuries, developmental hip dysplasia, slipped capital femoral epiphysis, Legg-Calve-Perthes, and ankle fractures.  Part 4: “Chest Imaging” is composed of 5 chapters. Topics include congenital heart disease, aortic arch anomalies, mediastinal masses, chest infections, and asthma. Part 5: “Abdominal Imaging” covers 12 chapters. They include malrotation, pyloric stenosis. intussusception, appendicitis, inflammatory bowel disease, neuroblastoma, wilms tumor, trauma, nephrolithiasis, urinary tract infection, GYN cause of pain, and testicular torsion. Part 6: “Prenatal Imaging” is composed of one chapter that discusses methodologies of fetal imaging safety concerns and societal cost.

Each chapter is well organized to for ease of reading and quick reference and review.  A clear statement of 3-6 major issues begins each chapter in a table format with each issue phrased as a question.  It is followed by a table of statements that summarize the key points that are discussed in greater detail throughout the chapter. Each of these statements as well as most of the statements of “fact” throughout the book is qualified with level of evidence ranks. The classification system is divided into 4 levels: strong, moderate, limited and insufficient evidence. The methodology of how information is classified is included in chapter 2: “Critically Assessing the Literature.”

Chapter content is consistently organized throughout the book. Each begins with a section on “Definitions and Pathophysiology” that defines important concepts and reviews the relevant pathophysiology. Clinical findings, signs, symptoms and important historical information are often reviewed. The second section discusses epidemiology including prevalence and incidence data. All information is well referenced and described in relation to the study that reported the data. Study features including age ranges, patient numbers and study type are mentioned so the reader can formulate an assessment of the data. Commentary on the study is offered when relevant. The next section is “Overall Cost to Society” which describes studies on total cost and cost-benefit for diagnosis. If data are limited or no studies are available, it is clearly explained as such. Goals of diagnosis and therapy are then described with evidence-based discussion on therapeutic options.

Subsequent sections in each chapter are devoted to answering the questions posed in the issues table. As is expected with an evidence-based approach, this begins with a discussion on the author’s methodology for answering these questions. Descriptions of the databases searched and medical subject headings are described. For each of the key issues, a summary of evidence is written which is very helpful for later review. A detailed description of supporting evidence follows that reviews studies in greater detail which often includes Bayesian and parametric statistical results from each study. Finally, take home tables summarize the evidence and a few imaging case studies highlight features of the previous discussion and give every radiologist the satisfaction of viewing an image. Future areas of research and a complete list of references conclude each chapter.

Each of the chapters is thorough, and references are very complete. There are few actual cases, but the included examples having good images and figures are well explained. I recommend this book for any radiologist who participates in the care of pediatric patients. It is a “must have” for pediatric radiologists and fellows.  Neuroradiologists who take care of pediatric patients will be interested in the neuroimaging sections, but most of the book is not dedicated to neuroimaging. Residents who are interested in pursuing a career in pediatric radiology would be well served by having a copy.

I have not found a book on pediatric radiology that covers these topics in such an organized and evidence-based approach. The format is very easy to grasp and helpful when referencing and reviewing topics after the first read. In summary, this book explores pediatric radiology from an evidence-based approach that is well organized, well referenced, and I highly recommend it for practitioners of pediatric imaging.

Ebner FL, et al. Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management. Neurosurg Rev (2009) 32:287–301.  Straight forward and all inclusive review of lesions that affect the conus (or any other part of the spinal cord, for that matter).  117 references.

Sharma GK et al. Spontaneous intramedullary hemorrhage of spinal hemangioblastoma: case report.  Neurosurgery 65:627–628, 2009.  15th reported case of spinal hemorrhage from hemangioblastoma.  The number I take away is Velthoven (Neurosurgery 57:71–76, 2005) reporting a risk of spontaneous hemorrhage in patients with a hemangioblastoma involving the central nervous system of 0.0024 per person per year.

Testai FD, Gorelick PB. Inherited Metabolic Disorders and Stroke Part 1. Arch Neurol. 2010;67(1):19-24. This portion of the review focuses on Fabry disease and MELAS.  Seriously detailed, with something that looks suspiciously like a diagram of the Krebs cycle.

Franzini A, et al. Spontaneous intracranial hypotension syndrome: a novel speculative physiopathological hypothesis and a novel patch method in a series of 28 consecutive patients. J Neurosurg 112:300–306, 2010. Blood patch with fibrin glue in the lumbar spine.  Check out the degree of thecal sac compression in figure 2.

Sheerin F et al.  Magnetic resonance imaging of acute intramedullary myelopathy: radiological differential diagnosis for the on-call radiologist. Clinical Radiology (2009) 64, 84-94.  Nice comprehensive review of a myriad of cord abnormalities with good image quality.

Vermeulen RJ et al. Microcephaly with simplified gyral pattern: MRI classification. Neurology 2010;74:386–391. Visual grading scale that can distinguish normal children from abnormal children with MSGP.  Why do I need this?

Ponce FA, Lozano AM. Highly cited works in neurosurgery. Part I: the 100 top-cited papers in neurosurgical journals. J Neurosurg 112:223–232, 2010.  Number 1? Hunt and Hess 1968.

Ponce FA, Lozano AM. Highly cited works in neurosurgery. Part II: the citation classics. J Neurosurg 112:233–246, 2010. More inclusive citations not just directly published in neurosurgical journals. I liked #32b.

While not designed for the practicing neurosurgeon this soft-covered, 660-page, multi-authored (81 authors) text entitled Neurosurgery is well suited for neuroradiologists who wish to have a survey text describing the major concepts in neurosurgery in terms of diagnostic evaluation, differential consideration and treatment. To this reviewer, the text would be valuable to any section’s library and, in fact, to one’s personal library.

After introducing basic anatomy and diagnostic testing, there, in consequent order, are chapters on (1) brain tumors (adult and pediatric), (2) vascular lesions (aneurysms, AVMs, Dural AVFs intracebral hemorrhage) (3) head trauma, (4) developmental/acquired anomalies (adult and pediatric), (5) spinal tumors, (6) degenerative disk disease, (7) spinal: vascular disease infections, trauma, (8) peripheral nerve: injuries, lesions, compressions/entrapment, (9) cranial nerve compressions syndromes, (10) congenital brain and spinal anomalies, (11) functional and stereotactic neurosurgery for epilepsy, pain, movement disorders, (12) miscellaneous items such as radiosurgery, image guided NSG, and neurosurgical critical care.

As would be expected, there is no material on many neurologic diseases which don’t pertain to neurosurgery such as white matter disease, metabolic disorders and ischemic cerebral infarction. In a sense, the text is superficial in its coverage of complex disease and their treatment, but for a text trying to cover this entire field within limited space, the result is creditable and informative.

One only needs to read through this short 93-page soft-covered handbook to realize the ubiquitous nature of the APS (Hughes) Syndrome and how the prevalence of this syndrome varies with age. The first few pages deal with the various types of antiphospholipid antibodies (such as the Lupus anticoagulant and the anticardiolpin antibodies), and this short monograph then goes on to describe and illustrate the many syndromes associated with the presence of antiphospholipid antibodies (both primary and secondary). Of particular interest to readers of the AJNR is the explanations of the various CNS manifestations such as cerebral ischemia, epilepsy, dural venous thrombosis, transverse myelopathy, and MS like lesions on MR. The percentage of patients with such findings who have APS is surprisingly high. This book goes on to describe and illustrate other organ system involvement such as cardiac (vascular and coronary artery), skin, renal, obstetrical, diffuse vasculopathy, musculoskeletal. The differential diagnosis of APS in different areas and the treatment of APS are the final chapters.

Interventional radiology is a daunting subject for many radiology residents and fellows.  With Vascular and Interventional Imaging: Case review series, learning about vascular and interventional radiology for the boards and for the subspecialty examination in IR becomes a less intimidating task.  Like the other books in this series, this one is well organized and easy to read.  It contains 3 levels of cases: opening round, fair game, and challenge.  On one page, a case is shown along 4 questions.  On the next page, these questions are answered and there is a brief discussion about the case. Two references, one to the appropriate pages of The Requisites and the other to a recent journal article are also given.

There are a total of 171 cases encompassing both vascular and non-vascular cases.  Of note, there are no neuro-interventional cases in this book.  Understandably, the authors relied heavily on angiographic images, but there are plenty of cases where the correlative CT, MRI or plain film is shown.  The authors pay an appropriate amount of attention to many of the most commonly encountered interventional procedures. For example there are 4 cases which deal with IVC filters. The questions and discussions are clinically based, addressing such issues as when a certain procedure should be performed and the alternatives to performing a certain procedure.  One complaint is that some of the more subtle angiographic findings would have been easier to see if the images were reproduced with an arrow on the abnormality in the discussion page.

Overall, this book is recommended mainly to residents studying for boards and while they are on their interventional rotation.  This book is likely of limited utility to the audience of this journal as none of the cases are neuro based.

Here is my weekly educational contribution to the blog.  This presentation was put together by one of previous fellows and shown at a previous ASNR annual meeting.  The topic, CTA pitfalls in the evaluation of the acute stroke patient, continues to be pertinent to our daily clinical duties.

Here is the next educational presentation. This was also done by some of my previous fellows.  The topic is a bit unusual, but I think that the presentation is very good and should help our readers.

Suppressing the Mind: Anesthetic Modulation of Memory and Consciousness
Series: Contemporary Clinical Neuroscience
Anthony Hudetz and  Robert Pearce (Eds.)
Humana Press 2010, 252 pages, 38 illustrations, $189.00

This is probably the largest book in dimensions (15.1   inches x   12.1 inches) ever reviewed for the AJNR. When it arrived, it reminded me of a Rand McNally World Atlas that one places on a book stand. That initial observation aside, this 557-page atlas directly compares whole brain (filling a whole page) cryomaccrotome images (on the left hand page) with the corresponding high detail post vivo, 7 Telsa, T2 weighted MR images (on the right hand page). These images, anatomic and MR, are shown as axial, coronal and sagittal displays in 3 separate areas of the book. As one would expect, the images are detailed and while it does not diminish the value of the book, some “ringing” artifacts particularly noticeable on the sagittal images through the pons, are mildly annoying. The axial images in particular demonstrate how the deep transmedullary venous anatomy are so striking at 7T. The index lists all structures presented in the text and indicates every page on which that structure is demonstrated.

At the end of the book, there is a strange and frankly an unfair comparison made to 1.5 T images. For example the 1.5 T images are not of high quality and a series of images are labelled 1.5 T (T1) but the axial are T2 weighted. Furthermore to do a comparison between T2 images on 7T and T1 images at 1.5 doesn’t make sense to say nothing of the fact that the T1 W coronal image is blurry even before magnification, and the signal intensity is not balance between the two hemispheres.

Those caveats aside — and it must be noted that this 7T to 1.5T comparison is very minor part of the book — the labeling is extensive and instructive although the use if some terms is unusual, like ‘eyeball’ instead of globe. Also, in many places the authors clearly have arrows pointing to the sub cortical white matter and label these as gyrus. For a  review of both basic and more detailed brain anatomy the atlas serves its purpose; however, in some areas, like the brain stem, another recently published book Duvernoy’s Atlas of the Human Brain Stem and Cerebellum by T.P. Naidich, H.M. Duvernoy, B.N. Delman, et al is far more detailed and informative. Nonetheless, this atlas could be a reference text in a Departmental library. There will be few individuals who would desire this for their own personal library.