394 Matters arising J Neurol Neurosurg : first published as 10.1136/jnnp.58.3.394-a on 1 March 1995. Downloaded from

patients to have features of Briquet's syn- sons. National and international referrals customers should add £2 per item for drome. would still be attracted, and the Institute, postage and packing. Payments can be G D PERKIN which would continue to be closely associat- Charing Cross Hospital, made by cheque in sterling drawn on a Fulham Palace Road, ed with the hospital, would be assured of a bank, or by credit card W6 8RF, UK long term future. (Mastercard, Visa or American Express) High quality research and a first class 1 Ron MA. Somatisation in neurological prac- stating card number, expiratory date, and tice. J Neurol Neurosurg Psychiatry 1994;57: clinical service are the obvious objectives. your full name. 1161-4. They must both be achievable. There is now 2 Perkin GD. An analysis of 7836 successive new a unique opportunity to redefine the role of outpatient referrals. J Neurol Neurosurg The National Hospital. The exercise will Psychiatry 1989;52:447-8. Searching for the Causes of 3 Perkin GD. Pattern of neurological outpatient result in temporary inconvenience, disloca- Schizophrenia. By EVE C JOHNSTONE. practice: Implications for undergraduate and tion, and considerable expense. These can Published by Oxford University Press, postgraduate teaching. J R Soc Med 1986; surely be tolerated. Future generations of Oxford. (Pp 134). ISBN 0-19-262296-X. 79:655-7. patients and doctors will have cause to cele- brate the foresightedness of their forebears. This book consists largely of an account of British neurology: a national focus R LANGTON HEWER the work that Eve carried out University ofBristol, Johnstone Department ofNeurology, with a number of colleagues whilst she was We are grateful to Schapira and Marsden for Frenchay Hospital, a member of the Clinical Research Centre opening the national debate about the future Bristol BS16 1LE, UK Division of Psychiatry, of which I was privi- of The National Hospital and the Institute 1 Shapira AHV, Marsden CD. British neurology: leged to be the Head, between 1975 and of Neurology.' a national focus [letter]. 7 Neurol Neurosurg 1989. By 1988 the work of the Division on The National Hospital has, as the authors Psychiatry 1994;57:1 136. schizophrenia was more widely cited than of the letter state, been at the centre of neuro- that of any other department or institute in logical learning and development over many the world and this was in no small measure decades. In addition, it has been an impor- due to Eve Johnstone's tenacity and indus- tant centre to which difficult and unusual try. In addition to the first CT study of cases could be sent. I personally am grateful schizophrenia there were a series of clinical for the help that I have received from col- NOTICES trials-the flupenthixol stereoisomers study, leagues at The National Hospital over many the study of the adverse effects of anti- years. There will also be general acknowl- cholinergic druigs, The Northwick Park edgement for the excellent work done by the The 21st International Epilepsy Congress will be held on 3-8 September in study of first episodes of schjZpnhrenia and various units that go to make up the Institute the Northwick Park "functional " of Neurology. This work must continue. Sydney, Australia. Major topics are: Genetics and molecular study to which Eve Johnstone's contribu- Clinical service and research go together. biology of epilepsy; tion was pivotal and each of which to my Both should be practised to the highest pos- Surgical treatment of epilepsy in childhood; mind significantly clarifies major aspects of sible standards. Functional neuroimaging; Choice of drugs in the case of The National, in childhood the mechanism or scope of efficacy of an obvious potential conflict exists. Three and adult epilepsies; Epilepsy antipsychotic drugs. elements may be considered. and the law; Intellectual disabilities and This book gives a full and lucid account (1) Most patients prefer to be treated as epilepsy; and The role of psychiatry in of these studies; also of the major surveys of near as possible to their own home. epilepsy. For further information, contact: The Congress PO Box the defects of iJ.titutionalised patients with This would usually be in the nearest Secretariat, 1231, schizophrenia and the detailed follow-up of general hospital. There is consider- North Sydney, NSW 2059, Australia. Tel: + 61 2 956 8333; Facs: + 61 2 956 5154. patients admitted from a single Cadhment able agreement that referral further area (Harrow) over a 10 year period. This is afield should be the exception rather a substantial body of work and it is good than the rule, and there should that this succinct and factual account is on be sound clinical reasons for such Announcement from the British Neuro- record. referrals. psychiatry Association But is it justifiably described as Searching (2) Neurological disorders are charac- The 1995 Summer meeting-to include for the Causes of Schizophrenia? I noted terised by their frequency and their joint sessions with the British Associa- two curious omissions. The first relates to http://jnnp.bmj.com/ diversity. The vast majority of major tion for Psychopharmacology-will be the work we did between 1977 and 1983 on disorders such as stroke, head injury, held on 15-17 July in Cambridge the viral hypothesis. This surely represented and epilepsy are managed at general On 16 July BNPA will hold a scientific a "search for the causes of schizophrenia", hospitals throughout Great Britain. meeting with the theme of "movement dis- but it is not mentioned in the book. By The increasing number of neurolo- orders" and its AGM. On 17 July BNPAI 1984 I had come to the conclusion that gists now working mainly in such BAP will have a joint session on neuroimag- schizophrenia cannot be caused by an hospitals is ensuring an improved ing, psychiatry, and psychopharmacology. exogenous virus, a view which I suspect Eve

spread of neurological expertise. Short scientific papers and single case videos Johnstone shares. But, if so, it would have on September 28, 2021 by guest. Protected copyright. (3) There are now well established neu- by members of both associations will also be been interesting (and relevant to the title) to rological units throughout the United presented. For further details please contact hear her reasons for dismissing the viral Kingdom and most of these are in Ms Sue Garratt, 17 Clocktower Mews, hypothesis, which at one time we both general hospitals. They provide a London NI 7BB, UK. entertained. Again the documentation of high quality clinical service as well as For details structural changes in the brain by CT, undertaking teaching and research. of membership of the BNPA, MRI, and in postmortem studies tells us These are three of the elements that influ- which is open to medical practitioners in something about the disease process. But ence the debate about the future role of The psychiatry, neurology, and related clinical what does it mean? I consider that a crucial National Hospital. The question now arises neurosciences, please contact Sue Garratt at clue came from the finding in the post- as to whether a "stand alone" specialist neu- the address above, or Dr Jonathan Bird, mortem work that the changes are asym- rological hospital with its somewhat atypical Burden Neurological Hospital, Stoke Lane, metrical. This suggests that they represent a and selective clinical practice, a decreasing Stapleton, Bristol BS16 1QT, UK. deviation in a late component of brain evo- number of referrals, and no local obvious lution, and leads to the more precise population to serve, is viable in the 1 990s. hypothesis that the disorder relates to The National Hospital would undoubted- genetic variation that is homo sapiens spe- ly achieve much support from clinical neu- cific. But this hypothesis and the aspects of rologists throughout the length and breadth BOOK REVIEWS the work which were relevant to it (even of the country if it were to physically merge though Eve contributed as coauthor) get no with a major general hospital. A major mention in this volume. advantage of this arrangement would be that All titles reviewed here are available from What I conclude is that there are scien- a high quality, comprehensive neurological the BMJ Bookshop, PO Box 295, London tists who are predominantly empirical or service for a defined population could be WC1H 9TE. Prices include postage in the Baconian in their approach and others who developed. Such a model service would be United Kingdom and for members of the are hypothesis driven. Eve is towards one most valuable for educational and other rea- British Forces Overseas, but overseas extreme and I am towards the other. Book reviews 395 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.58.3.394-a on 1 March 1995. Downloaded from

Sometimes the approaches are complemen- frequently than in the past. These hamar- trated book which one can, if desperate, tary-hypotheses need to be tested and this tomatous lesions consist of cavernous easily read straight through from cover to can be arduous work, particularly in assess- spaces lined by endothelium and collagen. cover. It is not weighed down by references ing predictions about a disease process. Cavernous malformations may be discov- but concentrates on the bare facts with Some of the work described in this book, ered incidentally or they may be associated more detailed and extensive accounts listed for example, on the mechanism and range with a variety of neurological symptoms. as further reading in individual chapters. of the anti-psychotic effect is in this catego- Local haemorrhage into surrounding brain Particularly good sections are those on ry. But to expect the cause of schizophrenia parenchyma is invariably present but cata- oedema, vascular disease and trauma and to drop out of a follow up, however strophic haemorrhage exceedingly rare. there are useful updates on the prion dis- detailed, of 10 years of admissions to a dis- The editors of this book have set out to eases and the devastating effect of AIDS. trict general hospital is I think a mistake. At compile a complete manual for neurosur- The section on techniques of examining the this point the hard headed empiricist and geons by gathering together the large brain both macroscopically and microscopi- the woolly speculator part company. But amount of information about cavernous cally will be of value to practising patholo- the book has much of interest to say about malformations which has come to light over gists and give clinicians an insight into what what else went on in psychiatry at the last decade. Chapters have been con- it is possible to derive from pathological Northwick Park in these years. tributed by pathologists, radiologists and examination of the nervous system. T J CROW neurosurgeons and although there is some This book is to be highly recommended overlap this allows different viewpoints to as a cost effective answer to continuing be presented. medical education for clinician and patholo- Current Management of Cerebral The text is easily read and well refer- gist alike. Aneurysms. Book 15 in Neurosurgical enced. Illustrations are plentiful. The ROY WELLER Topics. Published by the American photographs of gross specimens, the photo- Association of Neurological Surgeons. (Pp micrographs and the diagrams are all very 327; $90). ISBN 0-9624246-6-8. clear. Some of the figures showing MRI and CT appearances are a little disappointing Current Diagnosis in Neurology. Edited This is a recent addition to the series of and could have been more carefully by E FELDMANN. Publisher: Mosby, St neurosurgical topics generated by the selected. Chapters on pathology, epidemiol- Louis, Missouri 1994. (Pp 399). ISBN American Association of Neurological ogy and clinical features contain a wealth of 0-8016-6963-4. Surgeons. It is a multiauthor book which factual and statistical data. The radiological covers all aspects of intracranial aneurysms. assessment of these lesions is covered in The preface to this book states that it is The book is set out in a standard fashion terms readily understood by those of us in "designed to provide neurologic practition- addressing the epidemiology, clinical pre- whom the very mention of the paramagnetic ers with a state of the art approach to the sentation and subsequent diagnosis of causes a peculiar kind of mental shutdown. diagnosis of neurologic diseases". The first intracranial aneurysms before embarking on The book could have covered 90% of thing to say is that it is not concerned with the perioperative and anaesthetic manage- what is important in less than half of the treatment, which is dealt with in another ment and subsequent surgical approaches present length and would in shortened form volume, and so in the absence of its sister to the various different aneurysms. The last reach its busy and factually overloaded tar- volume, this book deals with only part of few chapters discuss the modern expecta- get audience much more effectively. A good overall patient management and limits its tions of surgery, the role of endovascular buy for the departmental library. usefulness. treatment and discuss the management of DAVID HARDY With over 100 authors often giving a very familial and other unusual aneurysms. personal view on how to diagnose a wide On the whole, the chapters are well writ- variety of neurological conditions, it is per- ten and illustrated. All are extensively refer- An Introduction to Neuropathology- haps not surprising to find a wide variation enced, mainly from the American literature. Second Edition. Edited by J HUME ADAMS in chapter quality. My major criticism of the Although compiled by a neurosurgical asso- and D I GRAHAM. Publishers: Churchill book is that too many of the authors have ciation, the individual chapters are written Livingstone, London 1994. (Pp 417; relied on personal experience rather than by a variety of specialists which serves to £35-00). ISBN 443044953. literature review and scientific method in generate the important theme that manage- compiling their contributions. This was ment of subarachnoid haemorrhage is now Through pioneers such as Charcot, obviously a deliberate editorial policy as the http://jnnp.bmj.com/ considered a condition that demands a mul- Alzheimer, Bailey and Cushing, neurology, volume is poorly referenced and each chap- tidisciplinary approach. I suspect therefore neurosurgery and psychiatry bear a heavy ter merely provides a few references for sug- that this book will be of great interest to a collective responsibility for the development gested reading. In these days of economic variety of specialists including neurosur- of neuropathology. It is perhaps ironic that justification and health reforms we cannot geons, neuroanaesthetists, neurointensive an understanding of pathological mecha- simply request expensive investigations, care specialists, neurophysiologists and nisms and the structural changes that occur such as gadolinium enhanced MRI, on the neurologists. This is particularly so as a in the brain and spinal cord has become basis of anecdote and expect neuroradiolo- large section of this book is devoted to the even more important to the practice of gists to exceed their budgets in providing on September 28, 2021 by guest. Protected copyright. aspects of perioperative resuscitation and clinical neuroscience through the develop- such investigations. Neurologists not only the management of complications. ment of imaging techniques and molecular need to be aware of what a test could iden- In summary, I would strongly recom- biology. Interpretation of MRI and CT tify, but also the diagnostic yield in the elu- mend this book to the aforementioned spe- requires a basic knowledge of anatomy and cidation of a diagnosis using that particular cialists who are dealing with patient3 of functional neuropathology and the rela- investigation. Most of the information con- suffering from subarachnoid haemorrhage. tion.< hip of molecular genetic defects to tained within this book would already be A lot of the information provided is applica- clinical neuLrology and to potential thera- present within the temporal lobe memory ble to a variety of neurovascular disorders peutic advances in tumour therapy and psy- banks of card carrying neurologists and it and hence may be of interest to a wider chiatric disorders requires an tmderstanding should appeal more to neurologists in train- readership. Even with the advent of of cell pathology. The recognitioI; that ing or general physicians and other speciali- endovascular methods, the principles laid pathology plays an important part in the t es. down in the book will almost certainly practice of clinical neuroscience is reflected Having said all this, there are several remain valid for many years to come. in the increasing requirement for pathology excellent attributes to the book. In particu- P J KIRKPATRICK in educational programmes for trainees and lar, there are very good chapters on some of trained alike. The question in everyone's the muscle and vascular diseases and the mind is how to find the time and material use of tables throughout the book makes for Cavernous Malformations. By ISSAM A for keeping up to date with neuropathology. easy reference. It was also enjoyable to read AWAD and DANIEL L BARROW. Publishers: Although called an Introduction to about how certain people approach the American Association of Neurological Neuropathology, the book by Adams and diagnostic process. Overall, however, this Surgeons, USA 1993. (Pp 224; $90). ISBN Graham is also a useful update on basic was an opportunity to produce a definitive 1-879284-07-3. neuropathology. Gone are the old mystical text on the criteria for diagnosing neurologi- terms, which often made neuropathology cal diseases which has unfortunately been Since the advent of MRI, cavernous malfor- opaque to the outside world, and in their missed. mations have been diagnosed much more place is a concise, well-written, clearly illus- JOHN ZAJICEK