Book Review

Pediatric Neuro-Ophthalmology

N Engl J Med 1996; 334:1552-1553June 6, 1996

Article

Pediatric Neuro-Ophthalmology
By Michael C. Brodsky, Robert S. Baker, and Latif M. Hamed. 491 pp., illustrated. New York, Springer-Verlag, 1995. $150. ISBN: 0-387-94464-8

This small textbook seeks to bridge the fields of pediatrics and neuro-ophthalmology. It reflects the three authors' distinctive approaches to their subject and, like many multiauthored compendiums, reads like a series of authoritative monographs. This style accounts for considerable overlap of topics. But few medical students or physicians will read this book cover to cover. Most readers will use it as a manual to guide them in evaluating a child with decreased vision, double vision, optic atrophy, nystagmus, or other neuro-ophthalmic symptoms and signs. They will find much sensible advice on techniques of examination, the description of the clinical syndrome, the choice of investigations and diagnostic procedures, and appropriate management and treatment. A list of more than 2000 up-to-date references facilitates in-depth search of the literature.

The first half of the book deals with the afferent visual system, beginning with the apparently blind infant. This chapter has an excellent discussion of the causes of cortical visual loss. The writer makes the important point that cortical blindness is a syndrome and may be associated with a variety of cerebral malformations. The next three chapters cover congenital anomalies of the optic disk, the swollen optic disk, and optic atrophy. The numerous tables and beautifully colored illustrations of fundi make the book an invaluable visual guide to diagnosis for medical students and nonophthalmologists. This section is also replete with helpful flowcharts that illustrate, among other important developing conditions, the pathogenesis of optic-disk drusen and transient visual disturbances found in children. The second half of the book focuses on the efferent visual system. Clinical algorithms for the evaluation of vertical diplopia, and palsies of the third, fourth, and sixth nerves are fully illustrated by clinical photographs of faces.

I am particularly impressed with the final chapters, which provide comprehensive coverage of the neuro-ophthalmologic manifestations of neurodegenerative diseases, systemic disorders, and intracranial tumors and vascular malformations. Tables are widely used to classify the neurodegenerative diseases and the syndromes associated with prominent ocular motility manifestations, optic atrophy, or both. This section also provides an update on the genetics of lysosomal diseases and the molecular biology of mitochondrial disorders of childhood. Distinctive magnetic resonance images characteristic of optic glioma, Dandy–Walker cyst, pineal-region tumors, and vascular malformations have been carefully selected to illustrate each entity. The book's considerable strengths lead me to disagree with J.D. Flynn, M.D., who writes in his introduction that Pediatric Neuro-Ophthalmology is not a book for the beginner. On the contrary, the best use of this book will be made by medical students, residents, clinical fellows, and practicing pediatricians, all of whom need a well-illustrated and precise textbook to provide a rapid reference on the major neuro-ophthalmic manifestations of disease in infancy and childhood.

Shirley H. Wray, M.D., Ph.D.
Harvard Medical School, Boston, MA 02115