Tang Y, Mukherjee S, Wintermark M, eds. Emergency Neuroradiology: A Case-Based Approach. Cambridge University Press; 2015; 412 pp; $120
In another of the many case-based publications currently on the market, Emergency Neuroradiology, edited by Drs. Tang, Mukherjee, and Wintermark, the reader is presented with 170 type of cases in the familiar format of images, history, description of findings, diagnoses, differential diagnosis and key points. While most of these cases are emergent in nature, it is a stretch to consider some of the cases as emergencies (like a DNET or Wallerian degeneration or a hamartoma of the tuber cinereum or maple syrup urine disease, among others) to be emergencies. For the most part, however, the bulk of the case material is urgent/emergent in nature.
There are 3 Sections: Brain, with 6 chapters — cerebrovascular disease, trauma, demyelinating and inflammatory disease, infections, tumors, and miscellaneous; Head and Neck, with 7 chapters — facial trauma, infections, orbits, paranasal sinuses, temporal bone, tumors, pediatric conditions; Spine with 5 chapters — vascular disease, trauma, infections/inflammatory, tumors, miscellaneous. There are often multiple cases within a specific disease type, so there are more cases presented than it would appear in looking just at the Table of Contents.
The selected cases are for the most part appropriate for the major aim of the book; it certainly would assist any resident who is about to enter their ER or Neuroradiology rotation. The images are generally of high quality, but as is often the situation, the findings are not subtle; as many know, it is not the flagrant abnormality that results in difficulties but rather the subtle and frequently overlooked finding that is problematic. Someday a book with subtle/easy-to-miss cases will be published — that would be a well-read publication. Added to the fact that the findings in this book are obvious (which in an emergency is not always the situation), the findings are often labeled with arrows, which certainly diminishes the “quiz-like” format of the material. Curiously, some cases have images that have labeled findings while others don’t.
The initial chapter is on cerebrovascular disease and contains 23 types of cases, which are of particular importance because these are all “emergencies”, except for the sinus pericrani case. The authors of these cases do a good job showing a number of the CT perfusion metrics, although it would have been beneficial to have indicated on the presentation images which were the CBFs and CBVs. The complete scales for the Spetzler Martin scoring and the Borden scoring should have been included rather than mentioning just the score for that particular case.
For an imaging text, some points needed greater attention. For example, in a case of displaced right frontal calvarial fracture, the CT images are set at a brain window, and therefore a fracture cannot be seen with the settings shown, even though an arrow points to an area in the right frontal bone. From an ER viewpoint the authors needed to have mentioned the value of the thin CT sections, with the possible inclusion of multiplanar reformations. Similarly, this book could have done more than demonstrate interesting cases that can be emergent in presentation. It should have outlined how exactly a case with the described clinical presentation should be imaged. For instance, in the 2 cases of temporal bone fractures, it would have been proper to explain at the bottom of one page (which is left blank) exactly how one goes about setting up the imaging of the temporal bone (slice thickness, imaging plane, reconstructions). This problem is repeated in relation to many of the cases — that is, there are no explanations of how to perform the exam, yet there was abundant space to do so and keep the book the same number of pages. The case of Eagle Syndrome (hardly an emergency, because even the history indicates the pain was chronic) is a prime example of unused space. Perhaps in a second edition the authors could consider including information on how to perform the studies based on the clinical presentations.
In summary, the book is a nice collection of classic neuroradiology cases; residents and fellows would benefit by reading through the material.
