Mukherji SK, Nunez DB. Emergent Neuroimaging: A Patient Focused Approach. Theclinics.com; 2018; 318-536 pp; $386.90.

The August 2018 issue of the Neuroimaging Clinics, edited by Dr. Diego Nunez deals with very practical issues in neuroimaging, specifically Emergent Neuroimaging: A Patient Focused Approach.

The concept here is a good one because most chapters concern a particular symptom or symptoms. This is after all, how patients present to an emergency department. Thirteen chapters cover the more common situations in neuro-emergencies, although one could come up with scenarios, which have not been covered in separate discrete chapters, such as an acute cauda equina syndrome or thoracic lumber trauma. Thirty-eight authors contributed to this 216-page issue. The imaging is of high quality and the text is supplemented with important tables.

The chapters cover the following topics:

• Acute neurologic impairments, including adults with stroke with acute neurologic deficit (which includes the MGH stroke imaging algorithm);
• Thunderclap headaches (TCH);
• Non traumatic intracranial hemorrhage;
• Acute deficits other than stroke;
• Immunosuppressed patients;
• Pregnancy and the post-partum period;
• The unconscious/found down;
• Patients with special circumstances in the pediatric population (trauma/non-trauma);
• Head/neck injuries in the older age group;
• CT/MR in cervical spine trauma;
• Blunt neck trauma and associated vascular injury;
• Maxillofacial trauma;
• Radiation dose considerations.

Even for the seasoned neuroradiologist, the material in this issue deserves a studied reading since some approaches and concepts change over time. The chapter on stroke (chapter one) is important because it offers an update on imaging and criteria one can employ in assessing the ischemic brain and the suitability for treatment. One does wonder, however, why the authors, when discussing CBF and MTT maps, refer the reader to a catheter angiogram showing a MCA clot.

Discussion and illustrations of patients with thunderclap headaches and with spontaneous intracranial hemorrhage allow the reader to review the considerations and appropriate imaging. Particularly interesting were the discussions on reversible cerebral vasoconstriction syndrome (RCVS) and its variable clinical and imaging presentations. Other causes of acute deficits review infection, and while the findings are well known to neuroradiologists, the chapter serves as a reminder of these imaging findings; which is of particular help to trainees (residents and fellows). Given the increasing incidence of drug abuse, and in therapies, the usage of chemotherapy agents, recognition of the findings associated with both – shown here and summarized – are important. In this chapter (and in some other chapters) appropriate care to ensure optimal image depiction of the findings was not taken. (Figure 10D is one example, as are figures 5 and 12 in the Maxillofacial Trauma chapter). Overall, however, the quality of the images is acceptable. In the example shown (figure 12) of resolution of seizure induced hyperintensities (C and D) that finding is not clear and one could argue that the DWI is in fact more pronounced and the FLAIR image has not resolved.

The various infectious brain and spine etiologies in the acute emergencies are nicely summarized but space availability has limited the ability to show a variety of cases. The “found down” chapter is a worthwhile addition to this issue since physicians often evaluate such patients with no other useful clinical information. The images here are critical in the differential diagnosis. A good display of causative etiologies are shown in this excellent collection of cases. Additionally, neurologic emergencies in pediatrics is given special attention in this issue. While some entities are shown in prior chapters (such as HSV, venous thrombosis, and PRES), the review pinpoints how a child can be affected similarly.

Practical and useful chapters include those involving trauma; specifically head and neck injuries in older patients. CT/MRI in cervical spine injuries is a particularly well written chapter, with regard to blunt cranial trauma and an emphasis on vascular injury (the title says cerebral vascular injury despite that the vascular lesions shown are all cervical). There is, as one might expect, duplication of material from chapter to chapter, as mentioned above. For example, RCVS is described and illustrated in the TCH chapter, but also described in the chapter on pregnancy and the post-partum period; post seizure imaging is also shown in separate chapters and likewise for overdose.

This issue – with a new cover featuring a dynamic color combination – is a strong addition to the series of volumes of Neuroimaging Clinics. It is practical and the variety of chapters fulfill the intent of this publication. This is a recommended purchase for all radiology libraries (particularly neuroradiology) and should be read by all neuro fellows and residents, especially those going through their first rotations in the trauma/ER area.