Book Review

Neurology and Trauma

N Engl J Med 1997; 336:813March 13, 1997

Article

Neurology and Trauma
By Randolph W. Evans. 663 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $95. ISBN: 0-7216-4352-3

This book is an excellent review of the neurology of trauma. It addresses neurologists, neurosurgeons, and emergency medicine physicians. There are comprehensive sections on head trauma, spinal trauma, plexus and peripheral-nerve injuries, post-traumatic pain syndromes, environmental trauma, post-traumatic sequelae, and medicolegal aspects.

Strategies for the rapid diagnosis and management of head injury are well discussed, including historical aspects of cerebral trauma and post-traumatic syndromes. There is appropriate attention to post-traumatic sequelae with regard to the neurobehavioral, neuropsychological, and cognitive outcome. This particular aspect of head-injury treatment is not well discussed in the literature, but this book presents the issues completely and concisely. There is also an excellent chapter on the medical complications of head injury. The chapter on neuroimaging and closed head trauma has illustrative examples of contemporary imaging techniques, including computed tomography, magnetic resonance imaging, and magnetic resonance angiography.

The section on spinal trauma is equally comprehensive and complete. Discussion of the technical aspects of surgical treatment of spinal injury is appropriately lacking. The evaluation and management of post-traumatic sequelae of low back pain and neck pain are discussed in one chapter. An informative chapter on the management of sports-related neck and back injuries is included.

A separate section on post-traumatic pain syndromes takes up difficult issues, such as whiplash injuries, myofascial pain syndromes, and reflex sympathetic dystrophy and causalgia. These syndromes can prove to be challenging diagnostic and treatment problems, and this section provides a concise and informative guide for the clinician. The section on environmental trauma is esoteric, but comprehensive with regard to high-altitude injuries, diving injuries, neurologic changes related to space travel, and injuries caused by lightning and electricity.

The medicolegal aspects of neurology and injury often concern clinicians. The chapter on the physician as expert witness is a readable source of appropriate guidelines. Additional chapters, including those on the determination of competency in the brain-injured person and on pain and the tort law, address specialized neurologic practice and the interface between the medical and legal aspects of post-traumatic injuries.

Stephen M. Papadopoulos, M.D.
University of Michigan Medical Center, Ann Arbor, MI 48109