Neurology and Trauma

Neurology and Trauma is an edited text covering various types of neurotrauma—head trauma, spinal trauma, peripheral nerve injuries—and causes of environmental trauma, such as high altitude, diving, and lightning injuries. There are 39 chapters and more than 50 contributors, many of whom are widely recognized experts in their topic areas. The editor, a neurologist affiliated with the University of Texas in Houston, has also drawn on local expertise for several of the chapters.

Trauma is the most common cause of serious neurologic impairment and disability. Yet neurologists and psychiatrists often receive only minimal training in this area, and it is usually covered only in cursory fashion in neurology texts. Nevertheless, recent years have seen a proliferation of texts on traumatic brain injury, most edited by neurosurgeons, psychiatrists, neuropsychologists, or basic neuroscientists. This book is aimed primarily at neurologists, but it is also intended for physicians and neuropsychologists interested in neurotrauma. Nearly 40% of the book is devoted to traumatic brain injury, the topic in this book that will be of greatest interest to the readers of this journal. The choice of chapter topics clearly reflects the interests and needs of neurologists as a target audience.

The book is divided into seven sections. The largest are devoted to head trauma (14 chapters) and spinal trauma (6 chapters). Other sections cover plexus and peripheral nerve injuries, posttraumatic pain syndromes, environmental trauma, posttraumatic sequelae, and medicolegal aspects.

The head trauma section begins with an excellent chapter on epidemiology by one of the leading authors in this area (Kraus). There is a fascinating chapter on the history of cerebral trauma by Rose, with well-referenced discussions of trauma from ancient Egypt and the Bible to the nineteenth century. The chapter on noninvasive neuroimaging is organized around different types of gross pathologic consequences and compares the usefulness of CT and MRI for various lesions. It is well illustrated and fairly comprehensive. The chapter on neuropathology is by two leaders in the field, a neuropathologist (Graham) and a neuroscientist (McIntosh). It combines excellent discussions of structural pathology and neurochemical changes with recent information on potential treatments of early secondary injury.

The chapter on the postconcussive syndrome and mild head injury is very comprehensive and well referenced. I would have appreciated more synthesis of the information on differential diagnosis of postconcussive problems and interactions of neurogenic and psychogenic causes, but all the information is there for the reader to develop his or her own algorithms.

An excellent chapter by Capruso and Levin summarizes the cognitive and psychosocial consequences of head trauma, considered separately for adults and children. Prigatano offers a good, brief discussion of neuropsychological evaluation, aimed at neurologists and neurosurgeons. The author includes important points about the direct and indirect consequences of brain injury in interpreting neuropsychological evaluations.

The chapter on cognitive rehabilitation by Malec is a superb effort to summarize the state of the art of theory and research in this controversial area. In this well-organized chapter, Malec asks and answers the important questions about the efficacy of cognitive rehabilitation and ends with a plea for support of further research in this area.

The head trauma section includes a number of other fine chapters, most notably the one on sports injuries. The chapters on cranial nerve injuries and vascular trauma are well illustrated.

The other sections are of less direct interest to readers of this journal; however, several chapters cover problems that may be encountered in a neuropsychiatric practice. The chapters on whiplash injuries and pain syndromes are particularly useful. The chapters on medicolegal aspects are interesting. They are written by a neurologist/lawyer (Beresford) and are constructed more from a legal than a clinical point of view. It would have been helpful, for instance, to have some clinical guidelines for determining competency in addition to the legal information presented in that chapter.

There is one chapter on psychiatric aspects of trauma, but it is relatively short and superficial. There is nothing on treatment of psychiatric sequelae or on behavior disorders in patients with brain injury.

Several other topics receive limited attention in this text. Except for the chapter on cognitive rehabilitation efficacy and a discussion of rehabilitation of complications of spinal cord injury, there is little on neurorehabilitative treatment. Another weakness is a paucity of information on overall outcome of traumatic brain injury and other neurotrauma disorders. Individual predictors of head trauma recovery are mentioned separately in the chapter on neurobehavioral outcome, but there is minimal overview of natural history or guidelines for determining prognosis.

Despite these minor criticisms, this book should be a valuable addition to the library of anyone with an interest in head injury or other forms of neurotrauma. It is one of the best resources available on neurotrauma for those in neurologic practice. Those looking for more comprehensive information on some neuropsychiatric issues after trauma, such as psychiatric sequelae, behavior management, or psychopharmacology, may feel a bit shortchanged.¹ Most clinicians seeking a text on neurotrauma, especially neurologists, will certainly feel they got their money's worth.

Dr. Katz is Assistant Professor of Neurology, Boston University School of Medicine, and Director, Traumatic Brain Injury Program, Braintree Hospital Rehabilitation Network, Braintree, MA.