Clinical Neurophysiology 110 (1999) 200

Book review
edited by O.N. Markand and N.M.F. Murray
The Clinical Practice of Critical Care Neurology E.J.M. Wijdicks (Lippincott-Raven, l997, ISBN 0316947598, 432 pp., PriceUS$ 105) This book reects the experience of Dr Wijdicks in the neurologic Intensive Care Unit at the Mayo Clinic, a unit of 24 beds that accepts both medical and surgical neurological cases, and is run by Dr Wijdicks, a neurologist. The book comes with an attractive little booklet in which are printed essential and important tables of data and management guidelines taken from the text, and intended to t into the pocket of any interested resident. This reviewer has approached the book with some bias, since the book disappeared without trace from my desk within 12 hours of its arrival. Clearly, I thought, this was a good monograph, desirable above all other possible books and documents on my desk. I confessed to the Reviews Editor, and was delighted to receive another copy which I have secreted at home to guard from the predatory intentions of other potential seekers after knowledge. The book consists of one mans view of the subject. This is always an attractive format, and when it comes from a source of experience as wide as that provided by Mayo, commands respect. The start of the book is encouraging, consisting of a table detailing the indications for admission to a Neurologic ICU. The book proceeds to describe the general principles of management in critically ill patients, the equipment used for their care, and the management of specic neurologic disorders, and their complications. This is therefore a mini-textbook of the care of the critically ill neurologica1 patient. The concept of a specic neurologic ICU is relatively unexplored in the United Kingdom, where cost constraints have limited such care to a service provided by the Critical Care Specialists, usually anesthesiologists, for all clinical services. Evidence that specialised units such as that provided by Dr Wijdicks team, are more efcient or achieve better results than this hospital-wide model, is lacking, although the specialised unit approach its widespread in many countries, for example, in Germany, Switzerland and Austria. Comparative data would be most welcome in this age of universal cost constraint. For example, what is the comparative level of clinical severity of the different illnesses admitted to the various units and how does this selection bias colour the results? Are there real benets to patients in choosing earlier rather than later admission to the ICU? The detailed reviews of individual clinical problems contained in this book are most useful, and will be read avidly by neurologists in training, for whom this approach to the care of the seriously ill neurologic patient will provide some much-needed clarity. The text is written in a consistent, condent manner, reasonably well-referenced, but without an attempt to discriminate between different treatments on grounds other than precisely worded sequential recommendations in relation to specic problems. Thus the treatment of status epilepticus is discussed in a strict sequence of different therapies, one to be tried after the other, and the outcome is discussed in relation to the generality of therapies, rather than to the effectiveness of any individual treatment regimen. Nonetheless one is left in no doubt of Dr Wijdicks own preference for therapy in this condition. Such is the strength of course, of a single author monograph. This is a personal view based on considerable personal experience, rather than another tedious literature review, and as such this reviewer greatly welcomes it. What would Cochrane have to say about this? One criticism that should be appreciated by the reader seeking instruction is that the references are in many chapters not up to date, and are in all chapters quite selective. This is an almost inevitable defect in a single author volume that encompasses a wide range of neurologic problems. Clinical Neurophysiology is given its customary and conventional place in management in thc ICU, especially in the diagnosis and management of acute paralysis, e.g. GuillainBarre syndrome, in acute myasthe nia gravis, and in status epilepticus and viral encephalitis. Appropriately, the diagnosis of brain death is achieved without reference to the EEG, although its potential nding of low voltage activity in people with no brain-stem activity is recognised. The only topic perhaps neglected in the book is the diagnosis and management of high cervical cord trauma, especially at C24, resulting in quadriplegia, and ventilatory failure, a disorder that may also result from vertebral artery dissection, and from which recovery is relatively unlikely. Altogether this is a comprehensive monograph that will be read with great care by all those neurologists and neurosurgeons whose everyday practice involves patients managed in an Intensive Care Unit. Michael Swash MD FRCP FRCPath Professor of Neurology Royal London Hospital, UK PII S0013-4694(98)00110-2

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