Roos KL, Tunkel AR, eds. Bacterial Infections of the Central Nervous System. Series: Aminoff MJ, Boller F, Swaab DR, eds. Handbook of Clinical Neurology. Elsevier 2010, 278 pages, $258.
The current volume is a part of the third series of the Handbook of Clinical Neurology, dedicated to bacterial infection of the central nervous system. The book covers advances in the field of bacterial infections and includes a number of new topics. It provides insight into the pathophysiological mechanism of bacterial CNS infections and covers the main principles of modern antimicrobial therapy as well as bases for new therapeutic strategies. There is considerable emphasis on diagnostic techniques, particularly imaging and new laboratory tests. The volume is a combined effort of the distinct team of numerous chapter authors and the two volume editors, Dr. Karen L. Roos and Dr. Allan R. Tunkel.
As the successful approach to bacterial CNS infections is often multidisciplinary, the intended audience includes not only the neurologists, but also neuroradiologists, neurosurgeons, infectious disease specialists, and other physicians who may encounter these clinical conditions in their daily practice.
The book begins with three chapters that elucidate the general approach to the patient with a suspected bacterial CNS infection. The topics include the pathogenesis and pathophysiology of bacterial CNS infections, the principles of antimicrobial therapy, the lumbar puncture, and the cerebrospinal fluid analysis. Although it seems to be far from the everyday radiology practice, I find the first chapter to be an interesting review of the etiology, most common pathogens, pathogenesis, pathophysiology, and epidemiology of the most common CNS infections, useful for clinicians across all subspecialties including radiologists. In contrast to a decade ago, this information may now be of particular interest to the radiology community, as we all enter an era of molecular imaging and advanced imaging techniques when a more detailed understanding of the pathophysiology of bacterial infections could be of particular importance.
The chapter on lumbar puncture and CSF analysis is concise and offers practical information for the clinicians on bedside lumbar puncture technique, indications in patients with suspected bacterial meningitis, the role of meningeal signs in suspected meningitis, and management of post-lumbar puncture headaches. It provides excellent practical discussion on the role of head CT prior to lumbar puncture including both historical background and review of modern literature. The IDSA (Infectious Disease Society of America) guidelines for adults with suspected meningitis who should undergo CT prior to LP are included in this chapter. An excellent detailed review of the CSF analysis and its clinical implementation used in conjunction with clinical presentation can be found in the second part of the chapter.
A separate chapter is dedicated to provide a comprehensive review on the characteristic CT and MR imaging appearance of common CNS infections. This chapter is an excellent addition to the clinical chapters. It should be of particular interest to practicing radiologists as well as radiology residents and fellows in training and could be used as a quick reference text. Typical CT and MRI features of the most common CNS infections and their complications including bacterial meningitis, cerebritis and abscess, cranial and spinal epidural and subdural empyema, as well as septic thrombophlebitis, are discussed at length. Various manifestations of CNS tuberculosis, neurological findings in infective endocarditis, and most commonly encountered infections in neurosurgery patients are also covered. Large emphasis is placed on MR imaging as this technique plays a major role in the imaging of CNS. The biggest strength of this chapter is its descriptive text, variety of cases, and good quality of the CT and MR images. The images are well integrated into the text, the legends are well written, and the references are current. One notable drawback is the lack of representative advanced MR images such as MR spectroscopy images. Incorporation of these images into the text would be preferred.
The rest of the chapters cover the clinical aspects of the specific disease entities, including bacterial meningitis, brain abscess, cranial and spinal epidural abscess and subdural empyema, suppurative intracranial thrombophlebitis, neurological complications of bacterial endocarditis, and the infections of the central nervous system in the neurosurgical patient. Complementing these chapters are reviews of multiple CNS infections caused by specific pathogens including mycobacterial infections, rickettsial and ehrlichial infections, spirochetal infections, Whipple’s disease of the central nervous system, and toxin-mediated syndromes of the nervous system. All of the clinical chapters are extremely well written and informative and have a uniform style. Each chapter begins with an overview of epidemiology, etiology, pathogenesis and pathophysiology, and includes a detailed discussion on the clinical features, diagnosis, and management of specific disease entities with overall excellent high quality CT and MR images. Illustrations, pertinent anatomical drawings, and clinical tables are ample throughout the book and are generally of high quality. All of the chapters are well researched.
In summary, this book is well organized and easily readable, with virtually no major weaknesses. The quality of the paper and print is excellent. Descriptions are short, clear, and concise. This book is quite manageable in size, and any entity can be looked up quickly. Although some sections of this book may not necessarily be of interest to every reader, it can certainly serve as an excellent source of information.
Overall, the book fulfills its intended purpose of providing updated review of clinical features, pathophysiology, main principles and latest methods of modern antimicrobial therapy, and review of radiological findings and other common laboratory tests for various commonly encountered bacterial infections of central nervous system. It is a good, clinically relevant reference textbook that would be found useful by many neuroradiologists and clinicians dealing with this subject.
