Filippi M, Simon J, eds. Imaging Acute Neurologic Disease: A Symptom-Based Approach. Cambridge, UK: Cambridge University Press; 2014; 391 pp; 196 ill; $150.00

This 382-page multi-authored book, edited by Drs. Massimo Filippi and Jack H. Simon, adeptly and efficiently covers the breadth of acute neurologic disease, with focus not only on imaging but on clinical features as well. Given the variety of manifestations of neurologic illnesses, many of which require urgent or emergent evaluation and intervention, neuroradiologists need to be cognizant of the potential imaging presentations of such a variety of acute processes.

Within this book, there are a total of 23 chapters. These chapters are:

• Disorders of consciousness
• Delirium and confusion
• Intellectual dysfunction
• Headache
• Back pain
• Acute vision loss
• Dizziness, nystagmus, and disequilibrium
• Seizures
• Acute and subacute ataxia
• Syncope
• Fever
• Acute, focal neurologic symptoms
• Acute, multifocal neurologic symptoms
• Acute brain trauma
• Spinal cord trauma
• Bladder, bowel, and sexual dysfunction
• Parkinsonism
• Hyperkinesia, dystonia, and tics
• Non-Parkinsons’s disease tremor
• Neuromuscular weakness
• Paresthesias and dysesthesias
• Weakness and fatigue
• Hearing loss and tinnitus.

An appendix titled “Risks associated with imaging procedures in acute neurologic disease” concludes the book.

A total of 59 authors contributed to the 23 different chapters within this book, hailing not only from the United States but from prestigious institutions across Europe, Israel, and Canada as well. Of note, these authors come from a multitude of backgrounds. While many indeed are neuroradiologists and neurologists, this book also includes instrumental contributions from emergency room physicians, ENTs, neuroscientists, and researchers.

This book is organized by symptomatology, thus placing heavy emphasis on clinical features of acute neurologic illnesses. It is designed to “guide the clinician through a decision-making process”, as outlined in the preface. This is in contradistinction to classic radiology texts, which are, instead, usually organized by disease entities or anatomic locations. It may occasionally be difficult for the radiologist audience to completely comprehend some of the more detailed clinical features described, such as in the chapters on delirium and confusion, intellectual dysfunction, and neuromuscular weakness. Certainly, such symptoms do require thorough description, with importance placed on evaluation and testing, which is of relevance to clinicians directly treating such patients. At times, however, at least to this reviewer, these more clinically oriented chapters were challenging, some of which had a dearth of clinically relevant imaging.

The book is well-written and clearly organized. In general, each chapter begins with an introduction, providing the reader with possible approaches to the symptom being outlined in that chapter, then offering testing and imaging algorithms when clinically appropriate. The authors then typically provide examples of disease entities with pertinent imaging characteristics, predominantly on CT or MRI, although intermittent examples of nuclear medicine or conventional angiography are also employed. Interestingly, several chapters delve deeper into advanced imaging techniques such as functional MRI as potential problem-solving tools, including in patients with altered consciousness and traumatic injuries. Although perhaps not necessarily relevant or applicable to all clinicians, particularly in the emergency room setting, this may be appealing to neuroradiologists and researchers interested in the applications of such advanced imaging techniques.

From a radiologist perspective, the vast majorities of the images utilized in this book are of excellent quality and are clearly labeled or annotated. Most authors are effective at highlighting key imaging points using specific examples. In only very infrequent circumstances were some images either too small in size to appropriately interpret or poorly annotated, which can be easily remedied on any potential future edition. One such example would be Figure 6.8 describing a sellar/suprasellar mass as a cause of decreased visual acuity, the imaging features of which were, to this reviewer, too small to effectively depict the finding. Another potential improvement would be to place more emphasis on stroke imaging in the chapter titled “Acute focal neurologic symptoms”. While much is fittingly discussed of the imaging techniques employed to image focal neurologic deficits, this reviewer found a relative lack of imaging itself to convey to the audience the importance of the radiologist’s role in the evaluation and management of patients with stroke-like symptoms. Perhaps a future edition could include such imaging.

The appendix in particular was a welcome surprise, vitally explaining the risks associated with imaging acute neurologic disease, including nephrogenic systemic fibrosis associated with gadolinium contrast agents, reactions to CT and MRI contrast media, and the risks associated with ionizing radiation. Certain hot topics that have garnered much recent attention are also briefly discussed, such as the appropriate imaging of pediatric and pregnant patients. Such knowledge is essential not only for radiologists but for treating clinicians as well.

Each chapter ends with a comprehensive and impressive list of references. The authors do an excellent job of incorporating information not only from current and recent literature, many (if not most) of which are articles from the last decade published in reputable journals, but also include material from some of the more established literature and books across an array of clinical, radiologic, surgical, and research disciplines.

Although by no means meant to be a comprehensive review of neuroimaging, Imaging Acute Neurologic Disease: A Symptom-Based Approach does, in this reviewer’s opinion, achieve its goals. The authors and editors do a fantastic job in covering a range of neurologic ailments that may present urgently or emergently. This book is highly recommended and would be a valuable adjunct to neuroradiology education, particularly at the resident and fellow level.