Brain, Vol. 122, No. 11, 2199-2200,
November 1999
© 1999 Oxford University Press
Book reviews |
NEUROLOGY IN PRIMARY CARE.
.
Birchfield Surgery, Cardiff, Wales, UK
The first thing to appeal to your average GP is the size of this book. It is a small book, easy to pick up, whereas a large book on Neurology could be fairly off-putting. Despite its size, it contains an excellent review of everything from the neurological examination to tests used in neurology. The book is laid out in an easy-to-read format and the chapters are all headed under clinical symptoms such as `Headaches', `Dizziness', `Memory Loss' etc. There are also sections on neurological emergencies, as well as an overview of the neurological examination. There are some sections that are so well written and so easily explained in terms of neuroanatomy that the book would also be excellent reading for medical students who are having their first attempt at neurology. For the busy GP, there is also a section at the end of each chapter called `clinical pearls', which lists half a dozen important statements to remember in relation to the preceding chapter. There are some aspects that are not relevant to general practice, in particular the post-lumbar puncture headache. I am not sure it is common practice in the UK for a small volume of blood to be drawn up and then injected epidurally, and as GPs we do not normally have to deal with post-lumbar puncture headaches. The chapter on nystagmus probably contained too much detail. GPs see people with back pain and neck pain on a daily basis and the emphasis in the section on backache was for bed rest for a short period only and mobilization when possible. It is also reassuring to see advice on cervical collars for neck injuries to be used to the bare minimum and for a few days only.
The book has sections on epilepsy, fainting and memory loss, and there are useful lists of blood tests which general practitioners could undertake when dealing with demented patients in order to exclude underlying causes. The sections on vision and hearing are particularly well explained, and again I thought this section would be useful for medical students to help them with the localization of the anatomical problem based on the clinical findings. The section on strokes is neatly divided up, dealing with deficits in relation to the territory of the cerebral arteries; it also gives some insight into the short term and long term outlook after strokes. Being an American book there might be some discrepancies between American and British medical practice. For instance, the book states that every person older than 50 should take a small dose of Aspirin daily to reduce stroke risk, but I do not feel this is everyday practice in Britain. Similarly, under neurological emergency, the book documents treating an acute stroke with plasminogen activator within the first few hours. The section on peripheral neuropathy brought back lots of memories of being a medical student and final exams. There were useful lists of blood tests to undertake from a patient with peripheral neuropathy, and a section on inherited myopathies reminded me of my medical finals oral examination and a mnemonic which is far too rude to mention in this review. No neurology book would be complete without a section on famous diseases, so GPs who read this book can feel free to add long names to the syndromes of some of their patients in practice even though they might only see one case in their career. The book is not just about neurology but also emphasises other important aspects of dealing with neurological patients, in particular the bladder problems associated with multiple sclerosis. My wife had to explain to me that when the author describes the spinal cord as the size of a `pinkie', it actually means your little finger
Page 180 has an typing error mixing up the 5th and 7th cranial nerves. Page 187 should be photocopied and given to all medical students when they start to try to understand neurology, and would also be a useful reminder to GPs of the principles of localization of a neurological deficit.
In general practice we often have to deal with patients with a neurological deficit without having organized expensive invasive tests. The tests available to a neurologist are discussed in this book, and these tests are all available to us given the right indications. I thought the book was well written and I was not put off by its American origin. The chapters were well laid out and the headings were relevant to clinical medicine. As previously mentioned, I thought there were excellent chapters on combining neuroanatomy with the localization of the neurological problem, and the `clinical pearl' section at the end of each chapter added as a useful reminder to the important points previously mentioned in the chapter. The author dedicates this book to the memory of his father who, he states, would have preferred a more scholarly book with lots of references. I tend to side with Dr Freeman, as I think he has got the balance of this book just right.
Notes
By Joseph H. Friedman. 1998. Oxford: Butterworth Heinemann. Price £17.99. Pp. 232. ISBN 0-7506-7036-3.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||