Book Review

Central Nervous System Infectious Diseases and Therapy

N Engl J Med 1998; 338:137January 8, 1998

Article

Central Nervous System Infectious Diseases and Therapy
(Neurological Disease and Therapy.) Edited by Karen L. Roos. 770 pp., illustrated. New York, Marcel Dekker, 1997. $195. ISBN: 0-8247-9811-2

This textbook, one of a series on neurologic diseases, is a multiauthored compendium intended for clinicians who diagnose and treat central nervous system infections. It is easy to be dismissive of such an effort, given the rapidity of recent advances in the field and the widespread availability of computerized literature searches. This book is so generally useful, however, that it is on my “desert island” list.

There are chapters on the various microorganisms that can infect the central nervous system. Most of these chapters begin with engrossing historical overviews, followed by discussions that cover the time-honored sequence of topics: pathophysiology, clinical presentation, diagnosis, treatment, and outcome. Tables and illustrations are used sparingly but to good effect. In general, the contributors are recognized authorities, the discussions are succinct, and the bibliographies are comprehensive. The neurologic sequelae of human immunodeficiency virus infection in adults and children are beautifully covered in chapters that are nearly up to date, a remarkable achievement for a textbook. Specific clinical syndromes in neonates, children, and adults are covered in other chapters, which are generally successful. The discussions of brain abscess, epidural–subdural empyema, and cerebrospinal fluid shunt infections are disappointing, suffering variously from imprecise terminology, outdated information, and in one case an inverted radiograph. The chapter on the neurologic complications of infective endocarditis is repetitive and poorly organized. The essential information is hidden by discursive prose, and one has to uncover it.

There are thoughtful contributions on several topics relevant to clinical practice but seldom reviewed: central nervous system infections in organ-transplant recipients and patients with cancer, infectious causes of facial-nerve palsy, and neurologic complications of immunization. The discussion of the neurologic complications of immunization is a nearly encyclopedic effort that curiously fails to discuss the provocation of vaccine-associated paralytic poliomyelitis by intramuscular injections. This epidemiologic observation (coupled with recent basic-science findings) may be critical for understanding the pathophysiology of these complications. The authors also devote only a scant paragraph to the notorious “association” between “swine flu” vaccination and the Guillain–Barré syndrome.

The critical care of patients with central nervous system infections often involves an uneasy division of labor between intensivists confronted by exotic infections and infectious-disease specialists amid intracranial-pressure monitors and ventilators. The chapter on critical care in this book, contributed by members of the team at the University of Virginia, is in my opinion the best available explication of the common ground.

Minor criticisms aside, this is an excellent book. A pleasure to read and easy to consult, it should be readily available to internists, neurologists, neurosurgeons, and other physicians who care for patients with central nervous system infections.

Charles J. Wrobel, M.D.
University of California, San Diego, La Jolla, CA 92093