J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.50.9.1251 on 1 September 1987. Downloaded from

Book reviews 1251 The eight biographies of disabled people differences. In the chapter on neirve blocking Intensive Care and Monitoring of the Neuro- with which the book begins demonstrate the procedures it is most refreshing tto see Charl- surgical. Patient (Progress in Neurological author's skill in empathising with individu- ton's cautious approach, criticalI analysis of Surgery Vol 12.) Edited by AM Landolt. als and outlining important aspects of aging methods and results, and warni ngs ("before (Pp 202; $74.00.) Basel: Karger, 1987. with disability. It is sad that there is no bet- embarking upon neurolytic block everyone ter book covering this topic. Why not? As should read the review of rnedico-legal It is unfortunate that this volume, dedicated the author says, saving lives attracts glam- aspects of complications that may follow to Hugo Krayenbuhl with such a good our and funds which are denied to services these procedures"). He states that intra- biography, has suffered the vicissitudes of for the saved. If this is true of spinal injury thecal use ofcold hypertonic saliine and bar- multiple authorship (so frankly acknowl- and poliomyelitis it is no less true of the botage of CSF "can now be regaLrded as his- edged in the editors' preface that it could be beneficiaries ofother miracles: for example a torical curiosities"; of epidural lblock "there taken as a lament upon this type of book); generation of people with spina bifida and is a distinct lack of published (data on the relatively little of the title is covered by the hydrocephalus now being launched into an injection of neurolytic solutions into the epi- contents, and the relationship of the eight adult world which has made no special dural space"; and neurolytic p;aravertebral contributions is seemingly haphazard. provision for them and which can scarcely and intercostal nerve blocks "frequently Neurological Evaluation of the Uncon- conceive that they will become old. have an unacceptably high itncidence of scious Patient by JD Miller gives a good CHRISTOPHER D WARD post-block neuritis". This sort of analysis account of the origin, simplicity and which the author supports with appropriate reliability of the Glasgow Coma Scale which references is much needed in pain-relief makes the addition of the Abnormal Flexor work. category to the Best Motor Response This approach contrasts with that in the unjustifiable since it requires somewhat chapter by Hitchcock on neeurosurgical expert recognition. The applicability of the The Therapy of Pain 2nd ed. Edited by Mark management. Statements such -as pain fol- Glasgow Coma Scale to neurosurgical con- Swerdlow. (Pp 271; £32-95.) Lancaster: lowing brachial plexus avulsic)n "usually ditions other than head injuries is well MTP Press Ltd, 1986. gradually disappears" is not suipported by presented. Wynn Parry who reports persistent pain in The chapter entitled Intensive Care of the guest. Protected by copyright. It is a pleasure to see the second edition of 90% of 108 patients (Pain 19i80;9:41-53); Head-Injured Patient is a comprehensive this book, a considerably altered and much there is as far as I know no evid[ence that in review of many of the topics which would be improved version of the first edition that causalgia increased amounts of nor- anticipated in a volume such as this but deals appeared in 1981. The title is perhaps mis- adrenaline are produced; and amongst with them so cursorily that little of practical leading, since it will not be obvious that this amputees "happily phantom iimb pain is value in patient management can be gleaned new edition now contains an outstanding relatively uncommon" does not accord with from it. Barbiturate therapy is given some chapter by Cervero on neurophysiological reports of persistent phantorm pain in prominence, and the control of ICP is sepa- aspects of pain which alone would make the 50-78% patients (Krebs B eta1. Adv Pain rated both from monitoring techniques and book worth reading and is one of the best Res Ther 1985;9:425-9; ShermaIn RA et al. artificial ventilation in such a way that the brief synopses of the theoretical issues of Pain 1984;18:83-95). Certainly not everyone inter-relationship of these is lost. The meta- pain mechanisms. Apart from this new would agree that patients with severe pain bolic and hormonal effects of head injury chapter on neurophysiology (which also from temporomandibular joinit derange- are well listed, and a valuable section deals with neurochemical aspects but little ment should be offered radiofre,quency tri- on coagulopathy following head injury on therapy), other new contributors have geminal rhizotomy if dental t]reatment is included. The Effects of Drugs on Neuro- taken over chapters on current views on ineffective, or if post-herpetic tiruncal neu- logical Examination is presented entirely nerve blocks and on oncological manage- ralgia persists longer than a few rmonths that from an anaesthetists viewpoint and gives no ment ofcancer pain. Two new chapters have surgery should be offered. Morreover, pro- account ofthe effects ofsuch common drugs been added, one on the vexed management cedures such as doral root entry:zone lesion- as alcohol, insulin and amphetamines. of low back pain, and the other, written by ing are discussed with no commeant on com- The Neuro-Ophthalmologic Evaluation of the book's distinguished editor is on assess- plications. Whilst there is much dlifference of the Neurologically Ill Patient is a very nice ment of the pain patient. Contributions are opinion and uncertainty when dlealing with survey ofclinical neuro-ophthalmology with brought up-to-date in the remaining chap- chronic pain, it is essential that oversimpli- little emphasis upon intensive care patients; http://jnnp.bmj.com/ ters on psychiatric aspects, the management fication is avoided, not least to a llow assess- it includes the all-important examination of of a pain relief centre, pharmacological ment oflong-term results and colImplications pupils and external ocular movements in the approaches, non-invasive methods, current of procedures. unconscious patient, and has some nice views on the role of neurosurgery, and pain These examples illustrate thte divergent explicit diagrams. relief and terminal care. approaches to pain and its managements The EEG and Intensive Care Medicine is a How does the new edition emerge from which the editor has allowed contributors to good chapter describing the relationship these changes? I think with flying colours, express. The reader will want to, and indeed between the EEG and levels of con- despite the variation in presentation and should, assess critically the viiews of the sciousness, ICP, and CBF. Computerised outlook to be expected in a multi-author authors, but will be rewarded by much inter- EEG techniques and practical advice is on September 25, 2021 by book. It will, however, leave the reader esting and up-to-date material, well refer- given, and the role of the EEG in the dia- bewildered and perhaps realistically dis- enced and covering a wide field. The book is gnosis of brain death would appear over- illusioned about the state of the art and reasonably priced, well produce d and is cer- emphasised had not the clinical bedside different approaches to the subject. Two tainly recommended. features been so clearly presented in Miller's chapters will serve to illustrate these GD SCHOTT contribution.