Book Review

Neurocritical Care

N Engl J Med 1994; 331:1663-1664December 15, 1994

Article

Neurocritical Care
Edited by Werner Hacke, with Daniel F. Hanley, Karl M. Einhaupl, Thomas P. Bleck, Michael N. Diringer, Allan H. Ropper, and Klaus Sartor. 1044 pp., illustrated. New York, Springer-Verlag, 1994. $98. ISBN: 0-387-56443-8

General-reference, multiauthored textbooks are ambitious undertakings. They require ardent editorial discipline to keep the book focused on the overall theme. In this book, the editors' purpose appears to have been twofold. They wanted to concentrate on management problems in the intensive care unit, including diagnostic procedures and therapeutic strategies, specifically as they pertain to neurologic patients, and at the same time to communicate a consensus view of these issues. The book has 7 editors and more than 100 authors from 50 institutions in both North America and Europe. Despite this diversity, the book is homogeneous in style and extremely readable. Each chapter follows a rather strict outline that includes definitions, epidemiology, pathogenesis, clinical features, differential diagnosis, diagnostic procedures, management and treatment complications, surgical management (when applicable), and prognosis.

This book will be most valuable as a quick reference manual in the intensive care unit. It is well bound, with a spartan but handsome cover. It has paper of good weight, which will stand up to extensive use. The type is easy to read, and the 125 figures and 248 tables make this book easy to use. The extensive subject index is also very easy to use. The chapters are short, ranging from 10 to 20 pages. The extent of the bibliography varies from chapter to chapter, and works are not cited within the text. Readers should therefore use the bibliography as a guide to more extensive reading on selected topics. Given the international authorship of the book and the complexity of organizing a book of this nature, I am pleased with the small number of typographical errors.

As a step toward achieving consensus on each topic at the international level, every chapter has more than one author, each from a different institution and country. The book is organized into four major sections, covering general approaches and monitoring and treatment strategies, differential diagnosis, specific diseases, and neurologic manifestations of internal diseases.

As one reads the book, it becomes readily apparent that the editors wanted to provide not an extensive discussion of the pros and cons of individual treatments but, instead, useful advice for the management of specific neurologic entities commonly seen in the intensive care unit. The reader is not bogged down by extensive references within the text, nor are there detailed reviews of the literature. Each chapter provides a straightforward management scheme. Readers will obviously find differences here from the way they might treat a specific problem; however, I see no important areas of concern.

It is difficult for a book of this size and scope to meet the requirements of everybody involved in the care of patients with neurologic disorders in intensive care units. Its audience will include nurses, medical students, residents beginning their training in intensive care, and physicians dealing with a new problem. The book is practical and does not provide extensive depth or detail. The first 100 pages focus on data gathering and monitoring, but there is little emphasis on interpretation and analysis or on nuances of management derived from these data. What the authors do provide is a good, though brief, review of each disease and its clinical management. In my opinion, the editors could have focused more on decision processes and deleted such topics as epidemiology and surgical management, which have been reviewed extensively in other works.

Recently, there have been a number of books on the neurologic intensive care unit. I believe this book is a good addition to that group because it provides a strong overview. It does not provide an extensive discussion of the vagaries of patient care, but rather a concrete, uniform opinion. The treatment strategies are reiterated and remain consistent throughout the book. The frequent use of tables and the excellent index make this a user-friendly book for the intensive care unit. Overall, I think it will be a useful addition to the neurologic intensive care unit's library.

Philip Stieg, M.D.
Brigham and Women's Hospital, Boston, MA 02115