Journal of Neuro-Ophthalmology, March 2004, Volume 24, Issue 1

Book Reviews

BOOK REVIEWS Section Editor: Barrett Katz, MD, MBA The Sankara Nethralaya Atlas of Neuro- Ophthalmology Kama Satya DNB, S. Ambika DNB, S. Padmaja DBN, Menon Smita MS, and Nikhil S. Choudhari MBBS. Jaypee Brothers Medical Publishers ( P) Ltd, New Delhi, India, 2003. ISBN: 81- 8061- 042- X. Scope: Founded in 1978, Sankara Nethralaya is a modern non- profit academic institute of ophthalmology in Chennai, India that cares for more than 1000 outpatients per day and employs faculty in 12 ophthalmologic specialties, includ­ing five neuro- ophthalmologists. This multiauthored 240- page atlas, written by the neuro- ophthalmologists from Sankara Nethralaya, is divided into eight color- coded sec­tions encompassing: 1) Afferent Disorders; 2) Efferent Dis­orders; 3) Congenital Disorders; 4) Infective Disorders; 5) Vascular Disorders; 6) Tumors; 7) Phacomatoses; and 8) Miscellaneous Disorders. Each section is alphabetically subdivided into two to three page chapters dealing with spe­cific disease entities or examination findings, such as ca­rotid cavernous fistula, fibrous dysplasia, melanocytoma of the optic disc, and optic atrophy. In addition to the multi­tude of high- quality color fundus and external ocular pho­tographs and radiographic images documenting disease en­tities, each subsection contains a concise textual overview of typical presenting symptoms, etiologic factors, physical findings, and applicable diagnostic testing. A list of four to seven references, many authored by highly esteemed neuro-ophthalmologists, is available for more detailed study. Strengths: With its intense focus on pathologic examina­tion findings and corresponding radiologic abnormalities, the book's disease- based construction allows for quick topic review and expanded reader exposure to challenging diagnostic realities, sure to infuse familiarity in the reader and improve diagnostic recognition and accuracy. Of par­ticular note are the inclusion of some less common entities, such as Crouzon's syndrome and Epidermal Nevus syn­drome and an excellent section on common, and not so common, orbital and intracranial tumors with emphasis on neuro- imaging differentiation. The atlas's greatest strength lies in the superb quality and the range of pathology- at times dramatic- captured in its photographs. The atlas also conveys a unique perspective into neuro- ophthalmology as a specialty in India and the range of pathology routinely encountered in Indian clinical practice. Weaknesses: The atlas is not intended to provide an exten­sive review on each topic or to be an all- inclusive textbook. There is some variation in the completeness with which subjects are discussed. For example, the sections on ophthalmoplegia and gaze palsies skim the surface of ad­mittedly complex and intricate disease categories- likely too complex and intricate to be adequately covered in the limited space. Recommended Audience: The appropriate audience for this atlas is medical students and residents, neurologists, neu­rosurgeons, and ophthalmologists. For students, details can be initially overwhelming in classic neuro- ophthalmologic texts; they will find this reference to be an excellent starting point for integrating difficult concepts with appropriate clinical and radiographic findings. Others will find it an easy- to- read, easy- to- reference, and broad pictorial review of neuro- ophthalmology. Critical Appraisal: The atlas is an enjoyable read, a con­cise and helpful overview of neuro- ophthalmology whose true value lies in the ample full- color photography and high quality corresponding neuro- images. If offers the student, resident, and practitioner the opportunity to improve diag­nostic skills via visual recognition of examination and di­agnostic testing abnormalities. Finally, and most uniquely, it provides exceptional insight into neuro- ophthalmology as an international field. Janet Rucker, MD Case Western Reserve University Cleveland, Ohio Basic Science, Refraction, and Pathology: The Requisites in Ophthalmology Morton E. Smith, Marilyn C. Kincaid, and Constance E. West. Mosby, Inc., St. Louis, 2002. ISBN: 0- 323- 00236- 6. Price: $ 89.00 Scope: As one of the " Requisites" series in Ophthalmology, this book deals with the topics of basic science, refraction, and pathology for the general ophthalmologist or researcher in vision science. Contents: The text is divided into three sections, each con­tributed by a separate author. The first section, by Kincaid, is about the basic science of ophthalmology. It is an exten­sive work that details basic molecular biology beginning with cell and DNA structure, and extends through prin­ciples of orbital anatomy, summarizing everything in between. The second section, by West, reviews ophthalmic op­tics. It is remarkably well thought out, easy to read, and surveys the optical topics with which an ophthalmologist needs to be familiar. There are useful discussions of Snell's law, internal reflection, vergence, focal points, lens formu­lations, multiple lens systems, and refraction. J Neuro- Ophthalmol, Vol. 24, No. 1, 2004 81 JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 Book Reviews The third and final chapter on ocular pathology is by a grand master: Smith. This section begins with melanomas but quickly encompasses the more typical format of ante­rior to posterior anatomy - cornea and sclera, to retina and optic nerve. Other sections include adnexal lesions, inflam­mation and infections, trauma, and glaucoma. Sadly, this is the shortest section ( only 18 pages). The photomicrographs are excellent, and the strength of the text material makes the reader yearn for more. Strengths: The section on optics is outstanding. It is ex­tremely understandable and exceeds most review chapters on optics incorporated within the classic ophthalmology texts. It should be required reading for any ophthalmology resident. Weaknesses: The section on basic science takes up half the book, and although it is well written and exhaustive, it strays from the implied premise of serving as an instant re­fresher and easy source of review. Recommended Audience: The book is most appropriate for the ophthalmologist, basic science researcher, or ana­tomic pathologist looking to refresh and update core vision topics. Critical Appraisal: I offer a mixed assessment of this book. The section on basic science is too encyclopedic to be considered an " instant refresher". The section on ocular pa­thology, while having beautiful illustrations and photomi­crographs, is too short. The saving grace of this book is the well- written and easily understood section on optics and re­fraction which alone makes it an excellent resource. Mitchell B. Strominger, MD Tufts- New England Medical Center Boston, Massachusetts Ultrasound of the Eye and Orbit. 2nd Edition Sandra Frazier Byrne and Ronald Green, MD. Mosby Inc., St. Louis, 2002. ISBN: 0- 323- 01207- 8. Price: $ 149.00 Scope: This multiauthored updated second edition is a comprehensive text about ultrasonography of the eye, cov­ering basic theory as well as ocular and orbital pathology amenable to ultrasound evaluation. Content: The book is divided into three divisions. The first division is composed of two chapters dealing with basic ultrasound theory and examination techniques. Throughout this section, as in the whole text, excellent diagrams and images are used to enhance the read­er's understanding. The second division covers intraocular echography. Five chapters dealing with ultrasonic evaluation of intraoc­ular anatomy and pathology cover vitreoretinal disease and intraocular tumors, trauma, inflammatory conditions, and glaucoma. Chapters 8 and 9 provide new information deal­ing with ultrasonic biomicroscopy and three- dimensional ultrasound. There is a greatly expanded chapter on axial length measurements, providing in- depth assistance of IOL calculations including a section on troubleshooting. The third division deals primarily with orbital ultra­sound, and includes expanded evaluation techniques, with emphasis on tumors and vascular lesions. Chapter 14 gives a succinct introduction to Color Doppler Imaging and its potential uses. Chapters 15- 17 cover the traditional ultra­sonic techniques in evaluating extraocular muscles, the op­tic nerve, orbital trauma, and periorbital disease; they con­clude with a helpful section on ultrasonic artifacts. Strengths: This is an extremely readable, well- organized text that continues to be an excellent reference standard for ocular and orbital echography. The diagrams and images accompanying the written material make for a seamless fit. The techniques identified are so well writ­ten that they can be easily reproduced in one's prac­tice setting. Weaknesses: No mention is made of the non- contact tech­nique for measuring axial length. An explanation of optical biometry using such technology as the IOL Master from Zeiss/ Humphrey would have further enhanced an already excellent section of axial length measurements. Recommended Audience: The text is applicable to anyone involved or interested in becoming involved in ultrasonog­raphy of the eye and orbit. The step- wise techniques are useful not only to technicians but also other health care pro­viders involved in eye care. The book will serve an excel­lent reference for medical students, residents, and ancillary medical staff. Critical Appraisal: The authors have written a compre­hensive text that continues to be a gold standard in its field. Ronald A. Braswell, MD The University of Mississippi School of Medicine Jackson, Mississippi Neurology & Neuroscience- An Internet Resource Guide Richard T. Johnson. eMedguides. com, Inc., Princeton, 2002. ISBN: 0- 9716450- 1- 9. Price: $ 21.94 Scope: This is a simple Internet resource guide, intended for patients, medical students, residents, and practicing physicians. Contents: This is a compendium of current neurology and neuroscience web sites of interest to practitioners, para­medical personnel, and patients. 82 © 2004 Lippincott Williams & Wilkins Book Reviews JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 Strengths: This guide can be updated on the web as content of sites or topics change and new sites develop. The mate­rial is logically outlined with a good description of each offering. The academic physician and the private practitioner can benefit from these defined sources of web- based informatics, especially so for those listed under " professional topics" and " clinical practice". The " patient education section" is also a good introduction to simple health and lifestyle issues. Weaknesses: It is unrealistically ambitious for any pub­lished work to attempt to be current with resources appear­ing on the Internet. Disappointingly, there are only five listed sites for neuro- ophthalmology, and they pertain to specific problems, including anisocoria, ocular myasthenia gravis, septo- optic dysplasia, sudden visual loss, and thy­roid ophthalmopathy. Were the general resource section to include the web sites of the North American Neuro- Oph-thalmology Society and the American Academy of Oph­thalmology it would allow access to information about dis­eases, signs and symptoms not otherwise covered. Recommended audience: Should one use such an internet resource guide, or just try Google? If that is the practical question before us, Google, or any broad search engine, seems to enjoy obvious advantage. Nonetheless, this is the perfect little book for anyone who is still more comfortable with hard copy. It is quite efficient and useful as a true re­source - a phone book of relevant websites - offering im­mediately available options. Office staff can also look up a site quickly for the concerned patient, and pass along useful sources of patient education. Critical appraisal: The authors have met their goal of cre­ating a resource guide to a subset of neurologically relevant services available on the Internet. Perhaps this compendium will be most useful to interested patient support groups. It could also be an asset in a busy clinician's office, although most residents and medical students will insist on some­thing more sophisticated. Pamela S. Chavis, MD Medical College of Virginia Richmond, Virginia Models of the Visual System George K. Hung and Kenneth J. Ciuffreda. Kluwer Academic/ Plenum Publishers, Norwell, MA 2002. ISBN: 0- 306- 46715- 1. Price: $ 115.00 Scope: It is difficult to imagine constructing a working model of the human visual system. From control of the ocu­lomotor system, to visual perception and comprehension, the task seems impossibly complex. This multiauthoredtext demonstrates how mathematics and engineering principles underlie the visual system and its acquisition and process­ing of images. The book has two purposes: To understand how the human visual system works, and to use models of the visual sys­tem to ultimately design artificial visual systems. It is tar­geted to college seniors and beginning graduate students in biomedical engineering, neurophysiology, optometry and psychology. It is the second in a series called " Topics in Biomedical Engineering", whose editor is Evangelia Micheli- Tzanakou. Content: The text is divided into five sections. Section I, optical system models, presents mathematical models of the cornea and lens. Section II, neurosensory system models, is a discussion of retinal anatomy and physiology, intraocular retinal prostheses, organization of the visual cortex, and mechanisms associated with voluntary saccades and atten­tion. Section III, oculomotor system models, presents mod­els of the accommodative, vergence, saccadic, and pursuit systems. Section IV, perceptual system models, discusses models for detecting texture, motion, visual attention, cog­nitive processing, and perceptual space. The final section, clinical system models, illustrates vergence model param­eters and clinical tests of vergence, refractive error devel­opment, reading disabilities, oculomotor system dysfunc­tion, and nystagmus. Strengths: The text is well organized; the editors have suc­ceeded in maintaining a consistent style throughout the chapters of their various contributors. Weaknesses: Although the chapter on retinal anato­my and physiology is excellent, most of the other chapters do not provide sufficient background material. The section on oculomotor control is particularly lacking in this regard. Basic scientists unfamiliar with strabismus and nystagmus would have an especially difficult time understanding these concepts. The chapter on implantable retinal prostheses is well written, but the book contains no discussion of arrays that can be implanted in visual cortex. The technology for im­plantable cortical arrays is especially promising and de­serves equal consideration. The chapter on models of reading disability is inter­esting but based principally on the anecdotal experience of the chapter's author. However, the topic of reading disabil­ity has received inadequate attention in the visual sciences, and its inclusion here at all is to be commended. Recommended audience: This book has topics that will be of interest not only to biomedical engineers interested in cybernetics, but also to physiologists interested in visual system function, psychologists interested in topics such as perception, attention, and cognition, and clinicians inter­ested in visual system dysfunction, especially reading dis­abilities and nystagmus. 83 JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 Book Reviews Critical appraisal: This book provides a comprehensive overview of the theoretical models currently available that describe visual processing and oculomotor control. The edi­tors have brought together leaders in the field of visual sys­tem modeling to describe how models are constructed and how models explain normal visual phenomena. Bradley J. Katz, MD, PhD John A. Moran Eye Center Departments of Ophthalmology and Neurology University of Utah Health Sciences Center Salt Lake City, Utah Microarrays for the Neurosciences: An Essential Guide Daniel H. Geschwind and Jeffrey P. Gregg. The MIT Press, Cambridge, MA, 2002. ISBN: 0- 262- 07229- 7. Price: $ 55.00 Scope: This guide is a reference book that provides a com­prehensive guide to the use of DNA microarrays in neuro-science. It is derived from a course on DNA microarrays presented at the Society for Neuroscience meeting in Mi­ami, Florida, in 1999. The course was organized by Daniel H. Geschwind, one of the editors of this book, who is Di­rector of the Neurogenetics Program at the University of California, Los Angeles, School of Medicine. Contents: Following the success of the Human Genome Project and private industry in sequencing the human ge­nome, the mouse genome, the Drosophila genome, and other bacterial and model organism genomes, a new disci­pline called " functional genomics" evolved. Functional ge­nomics is the study of the relationship between the genetic code and its functional expression in biologic systems. This book outlines the basic technology of using DNA microar­rays to monitor the expression patterns oflarge numbers of genes simultaneously, rather than looking at one gene at a time. It presents array scanning and image applications, sta­tistical methods for array analysis, specific applications of gene expression studies in the central nervous system, the use of post- mortem human tissue, and novel methods for using microarray data to develop hypotheses about regula­tory networks. The book also addresses obstacles that neuroscien-tists may encounter in the study of comprehensive gene ex­pression within the nervous system. The central nervous system has the most cellular heterogeneity and tissue com­plexity of any tissue system. It is believed that most of the predicted 30,000 human genes will be expressed at some level within the central nervous system, whereas only a small subset will be expressed in any other particular so­matic tissue. Strengths: This book offers a concise description of the technique of DNA microarrays, as well a good introduction to a new area of genetics, with examples of laboratory pro­tocols for setting up these arrays. Weaknesses: The text is not easy to read because of tech­nical details and a dry writing style. The references at the end of each chapter are relevant and current, but because the field of molecular genetics is rapidly evolving, they will quickly become out of date. Recommended audience: Neuroscientists and laboratory staff actively engaged in genetic research would find this reference useful. Although it is not intended for the clinical neurologist, it provides some background in understanding the language and appreciating the advances that will soon influence the practice of clinical neurology. Critical appraisal: Overall, this book is an excellent refer­ence for understanding the technical aspects of DNA mi­croarrays. Compiled by respected experts in neurogenetics, it is a first comprehensive guide to this new technology. Jane W. Chan, MD University of Nevada School of Medicine Las Vegas, Nevada Systematic Evaluation of the Mouse Eye: Anatomy, Pathology, and Biomethods Richard S. Smith, Simon W. M. John, Patsy M. Nishina, and John P. Sundberg. CRC Press, Boca Raton, FL, 2002. ISBN 0- 849- 30864- X. Price: $ 139.95 Scope: Scientists drawn predominantly from The Jackson Laboratory in Bar Harbor, Maine have written this compen­dium of the literature with original material on the normal anatomy, development, general pathology, and methodol­ogy for evaluation of the mouse eye and adnexa. Contents: Organization is logically accomplished with four sections. Section I tells about Regional Anatomy and Development, a review of normal gross and microscopic features of the mouse eye. Section II discusses Issues in Mutant Mouse Evaluation, wherein mouse eye disease is reviewed, with an emphasis on genetics. Mutagenesis issues peculiar to the mouse are discussed. Section III, of Regional Ocular Pathology, offers a review of histopathol-ogy of the mouse eye. Section IV, a synopsis of Bio­methods, discusses the methodology of mouse necropsy, histologic examination, and techniques of mouse eye ex­amination in vivo. Strengths: This is a useful reference, well- organized for the researcher reviewing mouse anatomy and examination techniques. For the ophthalmologist, it is interesting read­ing, my favorite chapter is Heckenlively's section on the mouse ERG. The similarities between human and mouse eye anatomy and pathology are interesting, highlighted by the cover itself showing histology of the mouse anterior 84 © 2004 Lippincott Williams & Wilkins Book Reviews JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 chamber angle. The book comes with a CD- ROM contain­ing color photographs that supplement the black and white pictures within the text. It is all extensively referenced. Weaknesses: I do not recommend this book for initial learners in the field, but rather as a reference and source of literature review. Critical Appraisal: Dr. Smith, the principal author, brings ideal credentials and skills as an ophthalmologist, ophthal­mic pathologist, and research scientist to a stellar array of contributors who acquit themselves well in this awesome task of teaching about the mouse eye. They have created what should be an indispensable reference in the field of genetics and development, which has become especially exciting with recent strides in the sequencing and under­standing of the mouse and human genomes. Mitchell Vincent Gossman, MD St. Cloud, Minnesota Investigating Neurological Disease: Epidemiology for Clinical Neurology Albert Hofman and Richard Mayeux. Cambridge University Press, New York, 2001. ISBN: 0- 521- 00009- 2. Price: $ 59.00 Scope: This is a wonderfully compiled, crisply written monograph about the epidemiology of neurologic disease. It offers an overview of the quantitative methodology used in clinical research, and introduces the clinician to such practical tools as genetic epidemiology, decision analysis, meta- analysis, outcomes research, survival analysis, and their applications to clinical problems. Contents: The text is divided into two major sections. The first is quantitative, offering well- summarized guidance in the methodology used in epidemiologic research. There are discussions of design and analysis of clinical trials, a ge­netic approach to neurologic diseases, diagnostic research with clinical analysis and decision- making, research and prognosis, and particular studies in survival analysis. The book also illustrates how recent tools of molecular biology and genetics will interface with large- scale epidemiolog­ic analysis. The second section consists of 12 chapters summa­rizing the epidemiology of neurologic diseases. Topics range from cerebrovascular disease, through Alzheimer's disease and myasthenia, to prion diseases and migraine. We are reminded throughout how epidemiology affects our thinking about etiology, diagnosis, prognosis, and treat­ments. Each disease is approached in broad- stroke fashion, with summaries of the epidemiology of proposed etiology, diagnosis, prognosis, intervention, and implications for clinical practice. The presentation and discussion of all topics are built around neurologic signs and symptoms, and thus palpable to neuro- ophthalmologists. Every chapter has an up- to date bibliography. Chapters have the appropriate number of tables, graphs, and histograms to aid the reader. Strengths: The descriptions of quantitative techniques are not so excessive as to induce somnolence. Because each topic involves issues of basic interest to neurologists and ophthalmologists, the methodology begins to makes sense. Each chapter is well done, simply presented, finely written, and succinct. Weaknesses: This is not a text for the serious statistician or epidemiologist. If the cognoscenti of epidemiology are of­fended by the basic level to which this book is directed, the rest of us will not be. Recommended audience: The book will be of interest to neurologists, ophthalmologists, and neuro- ophthalmolo­gists. The text will be of value to the experienced clinician, as well as the beginning student. Critical appraisal: This book is a wonderful find; it is convincingly written, aesthetically presented, and pain­lessly digested. Barrett Katz, MD, MBA The George Washington University Washington, DC Neurology and General Medicine, 3rd Edition Michael J. Aminoff Churchill- Livingstone, New York, 2002. ISBN: 0- 4430- 6571- 3. Price: $ 159.00 Scope: In 1989, Michael Aminoff pointed out in the preface to his first edition of Neurology and General Medicine that medical care was becoming increasingly more sophisti­cated and complex. That fact is, of course, equally true to­day. It is a major factor behind the increasing specialization and sub- specialization in the medical profession, a devel­opment that has led to more restricted and limited commu­nication between physicians. Neurology and General Medicine was formulated to addresses this disconnect between generalists and special­ists in neurology, and to discuss neurologic issues in the context of general medical disorders. Contents: Most chapters present neurologic features of specific medical disorders. Many of the 11 chapters new to this 3rd edition, however, begin with a neurologic phenom­enon ( seizures, abnormal movements, abnormalities of consciousness) and explore how each may be a feature of a variety of several medical conditions. This dual organiza­tion is useful to the internist, the medical specialist, and the neurologist. 85 JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 Book Reviews The book includes neurologic manifestations and complications of specific medical illnesses ( such as diabe­tes and cardiac disease), surgical therapies ( such a cardiac surgery and organ transplant), altered pathophysiologic states ( such as hypotension, electrolyte disturbances, and infections), and normal physiologic states ( such as sleep and thermoregulation). Strengths: The monograph is multiauthored, but the chap­ters are uniform in their organization, with a common theme in outline form. Pathophysiology is emphasized and dis­cussed well, with abundant diagrams. Outlines and tables facilitate the organization and understanding of the mate­rial presented. Weaknesses: Photographs are in black- and- white; many are small, and of poor quality, limiting their usefulness. Recommended Audience: Dr. Aminoff takes a refreshing look at the interface between neurology and general medi­cine. His text fills a need for those who care for patients in the complex medical environment in which we work today, yet are not fully trained neurologists. Such an approach will most appeal to those in comprehensive and primary care, to generalists in the medical specialties, and to neurologists looking at the larger picture. Critical Appraisal: I highly recommend this book for its thoroughness and excellent discussion of neurologic issues and because " there is nothing else like it" in the integration of neurology and general medicine. Shelley Ann Cross, MD Mayo Clinic Rochester, Minnesota Neurology and Neurosurgery Basic Principles Frank P. Smith, MD. University of Rochester Press, Roches­ter, NY, 2001. ISBN: 1- 58046- 084- 4. Price: $ 150.00 Scope: The book " intends to be a reference source for all physicians involved in neurologic matters, as a single au­thored comprehensive neurology textbook." Contents: This is basically a neurology text. Topics are or­ganized in 17 different chapters in a very traditional format. The first eight chapters deal with pertinent basic sci­ence, from a short history of neurology and neurosurgery, to embryology, neuroanatomy, neurophysiology, neuropa­thology, the neurologic exam, neurodiagnostic tests, and neurogenetics. The reminder of the book deals with specific clinical conditions of the nervous system. The reader will find that each of the first eight chap­ters discusses the topic in a broad basis, does not get well into details and is sometimes superficial. This is especially true for the neurophysiology, neuropathology, and neuro­genetics chapters, as well as the section dealing with current neuroradiologic tests. The illustrations are pertinent and well annotated. Chapters 9 to 17 deal with specific clinical condi­tions. Many of them are introduced to the reader with a rather interesting historical comment. The clinical aspects of each of the topics are well discussed. It is clear that the author is a consummate clinician with a keen interest in teaching the importance of clinical neurology. Neuro- ophthalmology topics are essentially absent. Treatment and management discussions, on the other hand, are rather out- dated. For example, Multiple sclerosis treatment lacks discussion on current disease- modify­ing therapies. Strengths: The book clearly represents the personal knowl­edge and experience of the author. It presents classic neu­rologic concepts that must be an important asset of anyone dedicated to this field of medicine. Weaknesses: The text is not presented in a dynamic, reader- friendly format. Treatment strategies of many topics are rather out- dated. Although claimed within the book's title, this is not a neurosurgery textbook. A few remarks regarding surgical management options are made, but the text is far from being a surgical one. Recommended audience: Although aimed at residents and medical students, this book will not please them as they fa­vor informative short, precise and dynamic readings. Critical appraisal: This basic neurology text authored by an accomplished clinician is well organized and clearly written, with pertinent but often unattractive illustrations. Its dull and at times redundant format, as well as the lack of updated data, may disappoint readers. Alfio P. Piva, MD Doheny Eye Institute University of Southern California Los Angeles, California Neuroanatomic Basis of Clinical Neurology Arslan Orhan PhD. Parthenon Publishing Group, New York, 2001. ISBN: 1- 850- 70578- X. Price: $ 54.95 Scope: This is a teaching text aimed at medical students that provides an unusual and potentially useful way to learn about the structure and function of the brain. It looks spe­cifically at how discrete lesions of the central nervous sys­tem produce symptoms. Unfortunately, this valuable link between neuro- anatomy and neurologic disorders suffers from a critically high number of errors. 86 © 2004 Lippincott Williams & Wilkins Book Reviews JNeuro- Ophthalmol, Vol. 24, No. 1, 2004 Contents: The book is divided into five major sections. The introduction is short and reasonable. Section 2 on the cen­tral nervous system covers the brainstem well, but goes no further. Section 3 on the peripheral nervous system is fairly strong. Section 4 on the sensory systems commits only 20 pages to the visual system. Section 5 on the motor systems emphasizes spinal reflexes and a number of clinical syn­dromes that interfere with these reflexes. Altogether, neuro-ophthalmology is allocated 10 pages as part of the cranial nerves in section 3, and 20 pages as part of sensory systems in section 4. Strengths: The premise of this book is appealing. There are many excellent neuro- anatomic photographs and line drawings. Weaknesses: The amount of neuro- ophthalmology cov­ered in this 400- page text is meager. Moreover, when the author transitions to clinical signs and symptoms, he reveals a lack of appreciation of many of the subtleties of the visual system. For example, on page 230, he states that an " acute isolated painful ocular motor palsy is most commonly as­sociated with aneurysm of the branches of the internal ca­rotid artery". In fact, most painful third nerve palsies are of microvascular origin. Pupils, not pain, are the more impor­tant discriminating element. Other concepts are confusingly presented, such as what is the " false image" in diplopia. The author states that this " false image will always be peripheral to the true im­age." Clarity is lacking here. In the same section, the author writes that in third nerve palsies, there is enophthalmos, failing to clarify that the enophthalmos is apparent rather than real. On page 233, there is a drawing of the insertion of the superior oblique muscle that incorrectly suggests it to be at the supero- nasal aspect of the globe. Continued errors are discovered in chapter 13, which deals with the visual sys­tem. Here, on page 274, the author manifests ancient termi­nology and perspective by describing the eye as the " pe­ripheral visual apparatus." It is inappropriate to think of the retina as part of the peripheral as opposed to the central nervous system. On page 274, the author incorrectly describes the " Marcus Gunn pupil" as a measure of the efferent nervous system. The author then defines a positive swinging flash­light test as a negative RAPD. Recommended audience: A book that integrates neuro-anatomic pathways with neurologic disorders should be in­valuable, especially with the new curricula being promoted in medical schools. Unfortunately the lapses here would lead to many misperceptions for both medical students and residents. Critical Appraisal: The author has years of experience as a teacher at the Chicago Medical School, reflected in his el­egant writing style and synthesis of ideas. I would urge that the next edition incorporate revisions suggested by critical appraisals from clinicians. Alfredo A. Sadun, MD, PhD Keck / USC School of Medicine Los Angeles, California 87