There is a worrying trend for new books to be heralded by overblown publicity, akin to a B-list movie. Hankey and Wardlaw's Clinical Neurology is a case in point. Throwaway comments of prepublication reviewers are trumpeted, and the advertising department have been working overtime on their purple prose. Despite this, B-list this book definitely is not. It seeks to occupy the middle ground between the plethora of undergraduate texts on neurology and neurological examination, and the heavyweights used by practising neurologists for reference, such as Neurology in Clinical Practice by Bradley et al. and Diseases of the Nervous System by Asbury et al. (of which a new edition is just out). It occupies this ground well, and I think will be particularly appreciated by trainees in neurology and senior medical students. It is sumptuously illustrated, and in sections resembles an atlas. At times the illustrations have little to do with the text, and their inclusion seems to reflect the authors' enthusiasm for the topic and their sense of fun. Indeed, a feeling of excitement imbues the entire work, and there is refreshingly little sense of drudgery on the authors' parts.
The authors are two young(ish) but distinguished practitioners, in clinical neurology and neuroradiology, from Australia and Scotland. Over the past few months I consulted the book when faced with less common clinical conditions (such as neurosyphilis, limb-girdle muscular dystrophy, tuberculous meningitis and hereditary spastic paraparesis) and on the whole it provided an adequate overview and plenty of suggestions on differential diagnosis, investigations and further reading. Common disorders are also, of course, covered, and ‘specialists’ in these fields are bound to find fault. For example, an epileptologist felt that the chapter on epilepsy was a little ‘light’. I am not sure how much practitioners in the rest of the world will learn from the reproduction of Australian guidelines on driving after seizures, and even the most old-fashioned neurologist will be surprised by the inclusion of phenobarbitone as a ‘second line’ treatment of partial epilepsy. Also, some reference to concussive convulsions should have been included—a surprising omission given its characterization amongst Australian-rules footballers. For my part (as a clinician with an interest in neurodegeneration and neurogenetics), I felt that the very comprehensive genetic tests listed were somewhat unselective. Most are not available outwith research laboratories, and in any case should not be embarked upon without due consideration to the ethical implications for patients and their families.
In view of the authors' track records, it is not surprising that the chapter on stroke is outstanding. In fact it serves well as a stand-alone text on the topic and I found it splendidly comprehensive when preparing a lecture for medical students. What distinguishes this chapter is the authoritative tone of the authors and their sense of maturity:
‘The burning question is no longer whether thrombolysis (and carotid endarterectomy) is effective, but in whom it is effective, in whom it is ineffective, and in whom it is dangerous. At present it is not known exactly which combination of clinical and imaging features reliably identify patients who will benefit or be harmed by thrombolysis... Furthermore, the most effective concomitant neuroprotective, antithrombotic and anti-hypertensive regime, if any, remains to be established.’
I hope that in future editions, Hankey and Wardlaw will cultivate this same sense of reflection and perspective in the other topics.
The neuroradiology, again not surprisingly, is outstanding, and there are hundreds of CT scans, MR scans and angiograms to mull over. It would be churlish to pick fault, but the illustration accompanying the text on multiple system atrophy should have included a ‘hot cross bun’ sign, and the head CT from a ‘typical’ patient with Parkinson's disease, which is degraded by movement artefact due to head tremor, in fact calls this diagnosis into question (as Parkinson's almost never causes titubation in its idiopathic form).
At the end of each chapter, for further reading, there is a list of references, usually grouped under different subheadings. I was delighted by how many of my own favourites were included. In comparison with American texts, the references here tend to reflect British and Australian thinking and practice, and consequently are likely to be of more relevance to Commonwealth trainees. The lists are up to date and comprehensive and their study alone is likely to give the reader an in-depth knowledge of most topics. It will be hard work to keep the references topical, but I hope that the authors will do just this in future editions.
The most direct competitor for Hankey and Wardlaw is Adam and Victor's Principles of Neurology from the USA. This old favourite amongst neurology trainees is a more discursive and at times highly individual style. In resorting to bullet points and lists Hankey and Wardlaw appear to be more thorough and balanced, but perhaps they are unsure of what can be safely left out.
In the four months Clinical Neurology has been with me it has become a handy reference tool. Medical students and junior doctors have kept borrowing it (making the completion of this review somewhat arduous). Though its spine has become loose and many of the chapters are heavily underlined and highlighted, it is likely to remain on my desk and not consigned to the shelf.