Review by L Flood
This reviewer’s first day as a clinical medical student saw an introduction to a neurology ward. The abiding memory is of very cerebral types, all sporting bow ties, who could localise a brain stem lesion, whilst armed only with a strange hatpin, worn in their white coat lapel. The snag was that, in the 1970s, they then seemed quite unable to do anything about the diagnosis, so cleverly achieved. Then the radiologists came along and spoiled all the fun. Even the Preface uses the term ‘contemplative’ to describe the specialty in that era.
This book is great at reminding us that clinical skills do still count, and it certainly illustrates the degree of overlap with our work in otolaryngology. I had expected cranial nerve disorders and especially facial paralysis to be of relevance, but the chapter headings all reminded me that neurological causes of dysphagia, speech disorders, dysequilibrium, facial pain and even sleep disorders can present to us initially.
As entitled, it certainly is ‘illustrated’, and nicely so. There is excellent colour photography, reproduction of imaging in monochrome and many a diagram. The neuroanatomy can be challenging at times and it is amazing what one could tell from various types of pupil asymmetry (if only one could remember it all, of course).
The text makes for easy reading and is indeed colourful, with blue topic headings, orange ‘notes’ in boxes, bold print to break up paragraphs, and even green ‘Key Points’ or ‘Practical Tips’. On this occasion, that really worked well and it is tastefully done.
A feature that encourages the casual reader is the opening of each chapter with a clinical vignette, using some very witty titles and illustrations. ‘The Same Only Different’, for example, is a tale of sub-arachnoid haemorrhage, presenting as migraine. It is accompanied by a picture of sticks of dynamite and a lit fuse. ‘Bad News’ criticises an unfortunate clinician for failing to notice an absence of sweating on the sole of the foot, a first sign of autonomic dysfunction in the sacral plexus (obviously). We must allow our colleagues some amusement and the chance to demonstrate their expertise. This can even extend to the cremasteric or bulbocavernous reflexes, which we are reminded can be applied to males only. The anal wink reflex I would not recommend to ENT surgeons, certainly not without a chaperone, and the eliciting of all these is best left to the specialist reader.
I was surprised not to read more of neurological dysphagia and even more foxed to find no mention of motor neurone disease in the index. Recent clinics have brought home to me how such conditions can present to us, but the penny dropped as I searched around and found amyotrophic lateral sclerosis instead.
This book is a ‘must read’ for trainees and especially those facing end-of-training clinical examinations. It is great value for money, and could be of far more use to that audience than the latest book on endoscopic nasal surgery or facioplastics.
Amazon Link: Fundamentals of Neurology: An Illustrated Guide, 2nd ed
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