Book Review

Pediatric Neuropathology

N Engl J Med 1995; 332:1454May 25, 1995

Article

Pediatric Neuropathology
Edited by Serge Duckett. 954 pp., illustrated. Baltimore, Williams & Wilkins, 1995. $169. ISBN: 0-683-02680-1

Perhaps for obvious reasons, the phrases “high adventure” and “pediatric neuropathology” do not often roll off the tongue together. Nevertheless, Pediatric Neuropathology is a highly adventurous book. Indeed, the subspecialty orientation the title suggests is belied by the book's extraordinarily varied contents and contributors. The book brings a multidisciplinary approach to diseases of the developing nervous system, for both specialists and general physicians. In 43 chapters by 71 authors from many countries, the subjects range from classic pediatric neuropathology to topics not traditionally incorporated in neuropathology textbooks, such as epidemiology, ethics, neuropsychology, radiology, clinical neurophysiology, gene therapy, and even enuresis.

Many of the chapters are elegant, detailed, up-to-date reviews that will certainly be useful guides for general physicians and reference sources for specialists. The chapters on forensic neuropathology and vascular diseases are particularly good, but it is difficult to choose among many excellent contributions. The illustrations are of high quality in many chapters, a feature integral to the success of any neuropathology book. In particular, the contributions on mucopolysaccharidoses, neurosonography, and embryology, as well as a few of the chapters that address malformations, are beautifully illustrated.

Adventure always entails risks, however, and risks do not always pay off. In this regard, Pediatric Neuropathology suffers quite strikingly from the two common flaws of multiauthored books: overlap and variability. For instance, the excellent chapter on mucopolysaccharidoses does not discuss the neuropathological features of these diseases — a curious omission for a neuropathology book. On the other hand, the pathologic features of the Chiari type II malformation are reviewed in four chapters, including two long, overlapping chapters on malformations (one of which is deceptively entitled “Hydrocephalus”). Similarly, perinatal hypoxic–ischemic injuries are discussed in at least five chapters, in varying detail. Although these topics are obviously essential to pediatric neuropathology, the extensive overlap makes the book repetitive and difficult to use. The variations among chapters are also remarkable. For example, an 8-page, 13-illustration, 3-reference chapter on imaging of the central nervous system seems almost gratuitous after a 51-page, 62-illustration, 275-reference chapter on neurosonography. Good, separate chapters are devoted to Alexander's disease and Canavan's disease, both exceedingly rare conditions, while more common leukodystrophies receive shorter shrift with the discussion scattered across other chapters. The two chapters on neoplasia are also uneven. The review of hereditary tumor syndromes details cutaneous innervation but barely addresses the molecular genetic findings that have revolutionized our understanding of these disorders. The chapter on brain tumors is extensive and copiously illustrated but somewhat idiosyncratic, with innumerable dense graphs and an oddly oriented overview of brain-tumor biology.

Who will benefit from Pediatric Neuropathology? Subspecialists, such as pediatric neurologists, pediatric pathologists, neuropathologists, and those rare birds pediatric neuropathologists, will find parts of it useful. The variability of the book, however, makes looking up any one topic a hit-or-miss enterprise. For general pediatricians, neurologists, and pathologists, certain chapters will no doubt be useful, but it is difficult to recommend the entire book to these audiences. Like any high adventure, therefore, Pediatric Neuropathology has many ups, but some downs; some spectacular views, but some arduous passages. And like an adventure, the book leaves us wanting more (perhaps a second edition) and admiring our guide for undertaking such an exciting and difficult excursion.

David N. Louis, M.D.
Massachusetts General Hospital, Boston, MA 02114