books book reviews

clinical neurology and neuropathology books

reviewed by T. Nelson


Neuroanatomy Through Clinical Cases

by Hal Blumenfeld
Sinauer, 2002 (951 pages)

For some fascinating Christmas reading, I recommend Neuroanatomy Through Clinical Cases. This book, oriented toward medical students, teaches basic neuroanatomy in short chunks, interspersed with lectures on performing the neurological exam, interpreting CT scans and MRIs, and bits of neuropathology relevant to the diagnosis. The reader is then tested by being asked to diagnose one or more clinical cases, which are presented with CT and MRI scans. The case and its clinical outcome are then explained. This is a remarkably effective way of teaching the material. Contains numerous MRI and CT images, color diagrams, and high-quality photos.

dec 28, 2010


Greenfield's Neuropathology, 8th ed

S. Love, DM Louis, and DW Ellison, eds.
Hodder Arnold, 2008 (2244 pages)

When some Internet bookseller gave me a 50% off coupon, I immediately ordered a copy of Greenfield's Neuropathology. The question is not whether Greenfield is better than its competitors, but whether there are any serious competitors at all. This book's only drawback is that after buying it, you may not be able to pay your rent or buy food for a few months. But that's a minor inconvenience for such an important book.

This is the most generally useful book on neuropathology that I've seen. Covers the neuropathology and molecular biology in clear prose with outstanding color diagrams.

Disclaimer: I have not yet read this book in its entirety.
dec 20, 2009


Neurology and Trauma, 2nd ed.

R. W. Evans, ed.
Oxford, 2006 (802 pages)

Traumatic brain injury is a very widespread and devastating condition, yet surprisingly little is known about its pathology. This book is a collection of short review articles on brain injury from a medical perspective. The format is typical of many multi-author books, where each author writes a short chapter. There is considerable overlap among chapters and relatively little depth or background. For example, the connection between head trauma and Alzheimer's disease is mentioned in several chapters, but never described in any detail. In one article, apolipoprotein E (a protein important in Alzheimer's) is mentioned, but none of the articles discusses the protein's function.

Some chapters (such as the chapter "The Neurobiology of Trauma") are more biochemically oriented, while others have interesting (and occasionally amusing, but usually not at all amusing) case histories. For the most part, the emphasis is strictly on clinical aspects, with most chapters containing little discussion of cellular or biochemical effects. The articles are more or less up to date considering the frustratingly slow progress that has been made in this field; most of the citations are to papers written before 2002. Most of the information in this book would be already familiar to a reader who has read the excellent (but old) textbook Neurological Pathophysiology by Eliasson et al., which is highly recommended. There are also several chapters on peripheral nerves and spinal cord injuries. Because of its clinical bias, Neurology and Trauma would be of greater interest to physicians than to researchers.

apr 7, 2007


Case Studies in Dementia: Common and Uncommon Presentations

S. Gauthier and P. Rosa-Neto, eds.
Cambridge, 2011 (305 pages)

This is a collection of 39 case histories that illustrate the differential diagnosis of different dementias, including Alzheimer's, Lewy body dementia, FTD, and ALS. Most cases have MRI and cognitive test scores, as well as behavioural assessment. The authors emphasize that, in most cases, the patients have mixed dementias, which can make the diagnosis challenging. Hence the need for this book.

For example, in Case 16 (“Personality disintegration—it runs in the family”) a 50-year-old man stopped caring about his personal appearance and lost his job for playing computer games at work. He became loud, apathetic, and inconsiderate, and began to eat more, gaining 10 kg in one year. MRI disclosed frontal lobe atrophy, and cognitive testing revealed the absence of memory impairment. He was diagnosed with frontotemporal dementia. He gradually became aphasic, and died five years later.

This patient's dramatic personality change could easily have been confused with a psychiatric disorder or midlife crisis, and many patients are initially treated as such. So how do we tell the difference? The authors say that patients with depression or psychiatric symptoms seldom are tactless but are typically oversensitive to other people's reaction. By contrast, even though patients with fronto­temporal dementia may exhibit symptoms similar to depression, such as social withdrawal, inactivity, loss of motivation, and sometimes alcohol abuse, they are unaware of breaking social rules and causing distress in others, and they typically lack insight into their condition, often to the point of denying that they are ill. Therefore, the authors suggest, evaluating social conduct and emotion processing is a good way of differentiating them.

Word-finding difficulty is a common complaint and can be an early sign of primary progressive aphasia or PPA. There are three types of PPA: semantic dementia, logopenic progressive aphasia (LPA), and progressive non-fluent aphasia or PNFA. Cases of each type are presented along with autopsy photomicrographs in many cases.

In another case (#23), a 39-year-old woman developed dementia, hallucinations, and ataxia after a tonsil­lectomy. Based on her MRI, she was thought to have vCJD (a rapidly progressive and fatal dementia related to bovine spongiform encepha­lopathy), but when they looked again at her chart, they noticed she had lost 55 pounds since the tonsillectomy. The correct diagnosis turned out to be Wernicke's encephalopathy, a disease usually associated with alcoholism. The woman had simply become malnourished due to dysphagia. She was given thiamine (the standard treatment for WE) and recovered, but still had some long-lasting cognitive impairment.

Many of the cases are tragic, and the personal detail drives home the enormous amount of suffering these patients and their relatives endure. The fact that autopsy results are included for the patients makes this book a bit depressing to read; some knowledge of brain anatomy is recommended. But it's fascinating to read: some of the diagnoses are obvious, and some are not. Ignore the guy on Amazon who says that the behavioural tests and blood workups are worthless. In the clinic, you'll have these results, and as Case #23 shows, they can save a life.

apr 28, 2019. edited may 06 2019