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Neuroanatomy Through Clinical Cases

Article  in  Journal of Neuropsychiatry · August 2002

DOI: 10.1176/jnp.14.3.351

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 BOOK REVIEWS

Jonathan M. Silver, M.D.
Book Review Editor
Neuroanatomy Through
Clinical Cases
By Hal Blumenfeld
Sunderland, MA, Sinauer Press,
2002, 951 pages, ISBN 0-87893-060-
4, $51.95.
Reviewed by José G. Merino, M.D.,
M.Phil., and Andrés Martin, M.D.,
M.P.H.
Starting with Andreas Vesalius’ De
Humani Corporis Fabrica (1543), anat-
omy texts have challenged in a fun-
damental way our understanding of
the human body and determined
how students are introduced to its
wonders. Neuroanatomy texts can
be especially enthralling to neo-
phytes, but by the same token can
turn them away from neuroscience
if coming across as dry, unengaging,
or irrelevant. As the Visible Human
project has successfully demon-
strated, progress in imaging tech-
niques and the endless possibilities
offered by cyberspace have led to
novel and exciting ways of teaching
and revisiting anatomy. Neuroanat-
omy Through Clinical Cases fits
squarely within such a tradition,
making it patently clear that an en-
tirely new textbook on something as
old and unchanging as the human
body and brain can be achieved.
And achieve it, this book spectacu-
larly has.
The unique and innovative quali-
ties of the book lie not only in the
clarity of its text and the beauty of its
illustrations, but also in its ability to
seamlessly weave the descriptive
with the functional, or the physiolog-
ical with the clinically relevant. This
feat has been achieved through a
counterpoint between “Anatomical
and Clinical Review” and “Clinical
Cases” sections. Four introductory
chapters provide a foundation on the
clinical interview, neurological ex-
amination, and imaging studies, so
that an integrated approach is feasi-
ble from the very start—even (espe-
cially) for first- and second-year
medical students, for whom this
book is likely to become a standard
text.
Indeed, the book has the early ca-
reer medical (or allied professions)
student clearly in mind. Review ex-
ercises, key clinical concepts, discus-
sion of clinical cases, focused ques-
tions, the liberal use of boldface type,
a wealth of tables and imaging ex-
amples, and user-friendly mnemon-
ics (the Spanish boca for [the aphasia
of] Broca being one of our favorites)
all make for an effective teaching ar-
mamentarium. Effective and fun: for
example, the above mnemonics are
indicated in the text with an icon de-
picting the hippocampus, and cere-
brospinal fluid anatomy is reviewed
in a “Scuba expedition through the
brain,” an approach that encourages
the student to literally visualize the
structures from the inside out. To top
it all off, an accompanying website
with video clips of the neurological
exam and a CD-ROM of all the illus-
trations (the latter available at extra
charge) complement the book and
are likely to make it as popular with
instructors as with students.
The remaining fifteen chapters are
divided along the traditional central
nervous system boundaries, and
include two chapters on the peri-
pheral nervous system, so often a
second-class citizen in other texts.
All chapters have an introductory
section detailing the neuroanatomi-
cal principles that govern the orga-
nization of the system under discus-
sion. Case presentations are recorded
as they would typically be found in a
detailed medical chart and pose
anatomically relevant questions that
highlight the chapters’ main con-
cepts. The clinical richness and tex-
ture of the book will thus make it use-
ful not only to medical students, but
to residents in neurology, neurosur-
gery, medicine, and psychiatry as
well.
Neuroanatomy incorporates a brief
but relevant discussion of circuitry
pertinent to psychiatric disorders,
and even throws in as epilogue “A
Simple Working Model of the Mind,”
which takes a solid and unpreten-
tious crack at some of the field’s most
enduring and intriguing questions:
what, and where, are mind, con-
sciousness, and emotion? While no
easy answers are provided, the book
does suggest where the author’s own
mind and emotions have been: it took
well over a decade of his time and
dogged commitment to compile the
materials and write the close to 1,000
pages of text. The personal touch
comes across not only in his writing,
but in Blumenfeld’s actual presence—
in photographs where he exemplifies
the finer points of the neurological
exam.
The author’s effort and commit-
ment are evident in the final product:
Neuroanatomy Through Clinical Cases
seems a slam-dunk into the classics
shelf. But that probably is not to be
its major accomplishment or acco-
lade: those are to be reserved for the
effect that the book is likely to have
on a whole new generation of stu-
dents—turning many of them on to
the excitement of the neurosciences.
We sometimes come across a book
we wish we had had when we our-

J Neuropsychiatry Clin Neurosci 14:3, Summer 2002 351

BOOK REVIEWS
selves were medical students and
residents. After stopping to think
about the possible effect such a book
would have had on our own devel-
opment, we resume our teaching en-
deavors revitalized, and recall in the
glimmer of our students’ eyes our
own first understandings. This is
such a book.
Dr. Merino is Assistant Professor of Neu-
rology, University of Florida, Jacksonville,
FL. Dr. Martin is Associate Professor of
Child Psychiatry and Psychiatry, Child
Study Center, Yale University School of
Medicine, New Haven, CT.
Cognitive Rehabilitation:
An Integrative
Neuropsychological
Approach
By McKay Moore Sohlberg and
Catherine A. Mateer
New York, Guilford Press, 2001, 492
pages, ISBN 1-57230-613-0, $55.00
Reviewed by Michelle Kornbleuth,
Ph.D.
In the past, research about the effi-
cacy of treatment and rehabilitation
for individuals who suffered ac-
quired or traumatic brain injuries
was limited. However, a surge of re-
search and literature over the past
ten years has opened up possibilities
for both clinicians and clients. Clini-
cians need to keep abreast of the ad-
vances in technology and treatment
that help to further their understand-
ing of clients with cognitive difficul-
ties.
In 1989, McKay Moore Sohlberg
and Catherine A. Mateer published
Introduction to Cognitive Rehabilita-
tion: Theory and Practice. The need for
a text that both reviews the literature
352
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to date on cognitive functioning and
provides a comprehensive overview
of theory has encouraged these au-
thors to produce a second book to
address the growth in the field of
cognitive rehabilitation and neuro-
psychology.
The new book thoroughly exam-
ines a variety of cognitive disorders
(some developmental, others a result
of acquired and/or traumatic inju-
ries) and informs the experienced cli-
nician, as well as the layperson, about
the anatomy and etiology of a disor-
der, the relationship between the
brain and behavior, and the type of
treatment that best suits the problem.
This book addresses the behavioral,
cognitive, and emotional aspects of
brain functioning required to practice
effectively and efficiently in cognitive
neuropsychology and rehabilitation.
It is recommended for all practition-
ers who work with individuals with
brain injury, as well as for students.
Within the context of advances in
cognitive rehabilitation, Part I intro-
duces theories, models, and disor-
ders associated with cognitive im-
pairments, along with the principles
of cognitive rehabilitation, new per-
spectives shaping the field, includ-
ing advances in technology, empha-
sis on empowerment, functional
approaches to treatment, and the
impact of emotions on treatment.
Recovery and assessment proce-
dures are specifically defined.
Part II comprehensively reviews
the theories, assessment procedures,
and approaches to treating and man-
aging the areas of cognitive function-
ing, such as attention, memory,
awareness, communication, and ex-
ecutive functioning, that can be af-
fected by brain injury. Along with re-
alistic case examples, the authors
provide practical questionnaires, ex-
ercises, tasks, and worksheets, includ-
J Neuropsychiatry Clin Neurosci 14:3, Summer 2002
ing a handout on attention strategies,
tasks to assess for executive function-
ing, charts to record daily thoughts,
and specific strategies and instruc-
tions for classroom accommodations
for children with cognitive impair-
ments.
It is noteworthy that the authors
discuss realistically the important is-
sue of reduced awareness in relation
to an individual’s ability to benefit
from treatment. Interviewing tips,
including specific questions, are pro-
vided to assess self-awareness and
adaptive functioning skills. In addi-
tion, they provide functional sugges-
tions to increase awareness in clients,
and they emphasize the importance
of support networks, specifically
family members. Interventions for
psychological sequelae of a brain in-
jury, as well as approaches to work-
ing with children and individuals
with mild brain injury, are covered
in Parts III and IV. Greater coverage
of the research and literature on the
benefits of neuropsychiatry of trau-
matic brain injury would be helpful,
but this is a minor criticism.
The authors’ new work has ex-
panded to cover the growing field of
cognitive rehabilitation. It presents
the research and clinical interests
pertinent to questions of brain–be-
havior relationships in children and
adults, with a range of disabilities, at
a variety of levels of functioning. It
is highly recommended as an ad-
junct to other texts on rehabilitation,
cognitive deficits, and neuroanat-
omy for neurologists, neuropsychol-
ogists, psychologists, psychiatrists,
social workers, speech and occupa-
tional therapists, caseworkers, and
students.
Dr. Kornbleuth is a clinical psychologist
affiliated with Lenox Hill Hospital, New
York, NY.