edited by R. W. Evans, 2nd ed, 802 pp, $135. New York, NY, Oxford University Press, 2006. ISBN 0-19-517032-6. Writing a book about a broad subject such as trauma, even if limited to neurologic injury, is a formidable task. How does one define neurologic trauma? Is it a stumbling baby's fall and the subsequent head bump that causes acute parental anxiety until everything returns to normal? Can such subtle and oft-forgotten events in our lives have dreadful consequences down the road? Or should we worry only when we “see stars” or visit the neurosurgeon for a modern day trepanation or trephination? How many neurons have been lost and might have been replaced had we seen a doctor sooner? How long has the blood-brain barrier been compromised? Where does this direct exposure of the brain to the body and the body to the brain lead? And so on. Since this book began as a Neurological Clinics volume, it would appear to have originally been written to introduce trauma to neurologists, who usually confront it in the guise of posttraumatic epilepsy or neuropathy or, alas, post–spinal tap headache. Ten years later, this second edition goes well beyond that noble cause. It has been revised and thoroughly updated, with eight parts and 20 new chapters. Overall, it is a well-written and organized book that will prove invaluable to neurologists, neurosurgeons, orthopedic surgeons, and emergency physicians. All the important issues relevant to injury in each of the three major divisions of the nervous system—head, spine, and nerves—are covered in detail. Indeed, combining material on all three in a single, readable volume is remarkable, since most textbooks are more specialized and deal with only one area. Part 1, “Head Trauma,” is exceptional. It contains chapters on epidemiology and history of head trauma, neuroimaging tools, neuropathology and neurochemistry (including novel cellular and molecular therapies), postconcussion syndrome and mild head trauma, posttraumatic neuropathies, epilepsy and intracerebral hemorrhage, neurovascular trauma, and medical complications of head injury. I especially enjoyed the chapters on posttraumatic epilepsy (with emerging information on the role of genetic and molecular factors) and medical complications of head trauma. Many consider such complications to be as important to outcome as the primary central nervous system injury, but they are usually overlooked by brain injury experts. The chapter on postconcussion syndrome, written by editor Randolph W. Evans, is one of the most captivating, owing to the author's thoroughness and subtle humor. The “Hollywood head injury myth” section, for example, summarizes what any physician and movie fan frequently observes: the resilience of film characters to repeated head injury. The two chapters on neurobehavioral outcome and neuropsychological testing complement later chapters on cognitive-behavioral rehabilitation and management of psychiatric sequelae. Part 2 deals with spinal trauma and contains chapters on spinal cord injury, medical complications (including a notable section on metabolic-endocrine changes after spinal injury), low-back pain, evaluation and treatment of sciatica, and zygapophysial joint trauma. Part 3 is dedicated to plexus and peripheral nerve injuries, with chapters on plexus injuries, occupational and use-related mononeuropathies, electrodiagnostic studies for the evaluation of nerve injuries, and surgical treatment of peripheral nerve and brachial plexus injuries. Part 4 examines posttraumatic pain syndromes (ie, whiplash injuries, myofascial pain disorders, and chronic regional pain syndromes) and includes a section on the use of botulinum toxin to alleviate these painful disorders and the mixed results so far. Although neurologists and neurosurgeons accept the pathophysiology of these traumatic conditions, there is still resistance in fully accepting the noncompensatory psychological and behavioral components. I found that these three parts, particularly part 4, are written in a readable format that provides a well-rounded view for the neurologist or internist who encounters these prevalent syndromes. Part 5 examines the association between sports and neurologic trauma. Oddly, a chapter on athletic plexus and peripheral nerve injury is not included, despite the presence of chapters on athletic head and spine injury. Part 6 deals with environmental trauma, with chapters on high-altitude and undersea diving neurologic trauma, lightning injuries, and electrical injuries. It concludes with the chapter “Neurology of Microgravity and Space Travel.” Although I doubt that the vast majority of readers will encounter a sick astronaut in their practice, I commend the editor for including such fascinating and futuristic information. Part 7 is entitled “Posttraumatic Sequelae and Medicolegal Aspects.” Movement and psychiatric disorders are known to be closely associated with neurologic trauma, and intracranial or spinal infections are not uncommon sequelae. Chapter 37, however, entertains the possibility that multiple sclerosis is associated with psychological stress and physical trauma. Although such theories have been around since the time of Jean-Martin Charcot, they remain highly controversial. Why is multiple sclerosis the only disease chosen in this context when there are so many neurologic diseases occasionally associated with trauma, eg, amyotrophic lateral sclerosis, Alzheimer disease, syringomyelia? I also found that chapter 38, “The Neurologist as Expert Witness,” although interesting, misses the point. Although it provides information for any physician called to testify in a legal case, it does not provide information on trauma: in fact, I did not find the word trauma anywhere. More relevant medicolegal information is included in an earlier chapter on whiplash injury. The final part of the book, “Iatrogenic Trauma,” is a welcome addition. Complications of lumbar puncture and nerve injuries occurring during various procedures or stereotactic brain or spine surgery, although highly undesirable, are not uncommon. Informed consent is usually obtained, but patients and families always wish to learn more when the untoward occurs. In that sense, this part enriched my knowledge on a subject that most people wish to avoid. In summary, the second edition of Neurology and Trauma is an enjoyable, encyclopedic compendium of basic and clinically relevant information on neurologic trauma and will be an important addition to the library of every medical professional interested in this topic. Back to top Article Information Financial Disclosures: None reported.
JAMA – American Medical Association
Published: Feb 7, 2007