BOOK REVIEWS
Neurologic and Neurosurgical Emergencies
edited by Julio Cruz, 596 pp., Philadelphia, W.B. Saunders,
1998, $145
Urgent medical1 conditions with neurologic manifesta-
tions are both common and important. Emergency room
care is challenged to screen large numbers of complaints
and identify the dangers. This text attempts to define “neu-
roemergencies” by problem, not specialty, and emphasizes
a multidisciplinary approach. The list of contributors in-
cludes neurologists, neurosurgeons, emergency physi-
cians, anesthesiologists, internists, ophthalmologists, and
intensivists. The multidisciplinary approach is also
strengthened by an international authorship. This diver-
sity leads to some variability in depth and style, but overall
readability is quite good.
The text contains 20 chapters that address clinical
problems, such as management of respiratory failure in
neurologic emergencies, as well as most common patholo-
gies, such as stroke, seizure, and hemorrhage. The section
on neuroemergency nursing provides a new perspective
and should broaden the appeal of the text. The discus-
sions are concise and contain basic pathophysiology as well
as practical management suggestions. Some discussions
should be shortened, such as the review of surgical man-
agement of various intracranial aneurysms, while more dis-
cussion of pediatric neuroemergencies would be welcome.
A thorough and detailed discussion of the physiology
and therapy of intracranial pressure (ICP) management is
included in the trauma section, emphasizing the issues of
tissue oxygenation and perfusion pressure. This thorough-
ness is contrasted to another chapter where recommenda-
tions for ICP management with meningitis include routine
hyperventilation and fluid restriction. Some inconsisten-
cies are expected given the diverse authorship, but key
concepts must be conserved.
Despite these minor points, the text is interesting, read-
able, and will be of interest to those who see acute neuro-
emergencies. Many excellent radiographs and illustrations
greatly enhance the readability. The references are up to
date and the index is quite useful. The book should be of
particular benefit to neurology and neurosurgical resi-
dents, as well as practitioners of emergency medicine.
Daryl R. Gress, MD
CCC 0148-639X/99/091301-02
© 1999 John Wiley & Sons, Inc.
Book Reviews
Practical Electromyography, 3rd Edition
edited by Ernest Johnson and William Pease, 398 pp., ill.,
Baltimore, Williams and Wilkins, 1997
The textbook is a product of the Physical Medicine & Re-
habilitation department of the Ohio State University
School of Medicine along with several invited extramural
contributors. The book has become a standard compo-
nent of libraries in most electrodiagnostic laboratories.
This new edition is organized into 13 chapters plus an
appendix of practical questions and a glossary of terms.
The book is well suited for beginning and intermediate-
level electrodiagnosticians.
The book begins with a chapter on needle examination
that is well suited for beginners. Following is a chapter on
quality improvement dealing with the process of design-
ing, performing, and reporting the evaluation. There is
then a discussion of quantitative techniques, a chapter on
instrumentation that provides a good basis for understand-
ing the technical underpinnings of electromyography, and
a succinct account of advanced needle examination tech-
niques such as single-fiber and macroelectromyography.
The chapter on the evaluation of the patient with sus-
pected radiculopathy provides a good scheme for the
scope of muscles to be included in the needle examination
as well as portraying the expected findings based on the
timing of the study. Some of the examples, though, are a
bit unclear with regard to the expected findings on stan-
dard nerve conduction studies, especially sensory studies.
The nerve conduction chapter is well done and takes the
reader from the electrophysiological basis of action poten-
tial conduction through the details of individual nerves.
The chapter on late responses gives a good basis for un-
derstanding the F wave, H reflex, and A waves. There is
some redundancy, however, because the H reflex is also
discussed in several other chapters. Separate chapters
cover carpal tunnel syndrome, entrapment neuropathies,
the brachial plexus, and peripheral neuropathies, while
the final chapter presents cases of weakness of different
etiologies and guides the reader through a logical electro-
diagnostic evaluation. The appendix of questions is a good
test of the reader’s understanding of the material pre-
sented in the book.
Overall, I like this book. The current edition lives up to
its title, as have the previous ones. Some of the illustrations
are dated and should be replaced by new ones. Some chap-
ter titles could be better selected to more accurately reflect
the content. Placing the nerve conduction chapter before
report writing and quality improvement are presented
would be desirable. These, however, are minor criticisms.
This is a popular textbook that, at least in my institution, is
in great demand among the residents and faculty of both
MUSCLE & NERVE September 1999 1301
the neurology and physical medicine departments. Res given the absence of a discussion providing some expert
ipse loquitur. perspective, the reader who is new to the field may be
puzzled or overwhelmed.
John C. Kincaid, MD The clinically oriented chapters are a mixed bag. Dun-
can reviews the important and sometimes vexing issues
related to measurement of stroke outcome. Goldstein’s
Restorative Neurology: Advances in summary of the effect of drugs on stroke recovery nicely
Pharmacotherapy for Recovery after Stroke outlines issues relating to current and future medical
edited by Larry B. Goldstein, 321 pp., ill., Armonk, Futura treatment. Samson et al. provide a balanced view of the
Publishing Company, Inc., 1998, $90 potential for functional neuroimaging to document neu-
roplasticity in brain recovery or to guide therapeutic inter-
Recent advances in neuroscience are offering new hope
ventions in rehabilitation. Other chapters look at prelimi-
for repair of the damaged nervous system. Medical treat-
nary and ongoing investigations using amphetamines,
ments designed to minimize or reverse the consequences
antidepressants, or gangliosides to promote functional res-
of stroke or brain injury are poised to become a reality in
toration.
clinical practice. Restorative Neurology tries to bridge the gap
This collection of reviews specifically focuses on the
between scientists and clinicians working in this area, by
foundation for treatment of ischemic injury to the central
summarizing progress and promise in the laboratory and
nervous system, although traumatic brain injury is also ad-
at the bedside. The goal is admirable, but the result is
dressed. There is no discussion of restorative pharmacol-
somewhat uneven.
ogy for peripheral nervous system disorders. Nevertheless,
The volume opens with Donald Stein’s excellent over-
several chapters offer useful information on growth factors
view of the theoretical basis for neural repair and reorga-
and gangliosides, two groups of substances that have at-
nization after brain damage. Following is a series of com-
tracted attention as therapeutic agents in polyneuropa-
prehensive discussions which emphasize pharmacological
thies. Nearly all chapters have helpful figures and illustra-
interventions in experimental models of brain injury. The
tions, and the references are generally published in 1996
reviews of noradrenergic modulation of physical therapy
or 1997. Being a multiauthored text, there are varying
by Feeney and the impact of GABA on functional recovery
writing styles and some repetition, but I found most sec-
by Schallert and Hernandez are particularly good. Unfor-
tions very readable.
tunately, there is no critical analysis of this extensive lit-
Restorative Neurology is not intended to be an introduc-
erature, and information sometimes appears confusing, if
tion to neurorehabilitation. Instead, it provides an in-
not outright contradictory. For example, in discussing cho-
depth look at neuropharmacology as it relates to medical
linergic pharmacology, Saponicj et al. conclude that “early
enhancement of stroke recovery. The editor has made im-
treatment (of brain injury) with anticholinergic drugs is
portant contributions to both our basic and clinical un-
beneficial to recovery of function.” Several chapters later,
derstanding of the effect of drugs on the injured nervous
Lopez-Coviella et al. review the potential benefit of CDP-
system. He presents a worthwhile survey of the state of the
choline (citicoline) which is proposed to improve function
art for those who are actively interested in the scientific
after brain injury “by increasing production of . . . acetyl-
basis of this emerging field.
choline.” No doubt that differences in experimental con-
ditions can lead to divergent conclusions and the neuro-
pharmacology in these situations is complex. However, Gary Abrams, MD

1302 Book Reviews MUSCLE & NERVE September 1999