Neurologic Complications of Critical Illness, Third Edition.  By Eelco F. M. Wijdicks, M.D., Ph.D. Series edited by Sid Gilman, M.D., and William J. Herdman, M.D. New York, Oxford University Press, 2009. Pages: 480. Price: $129.95.

Diagnosis and management of neurologic disorders in the intensive care unit (ICU) are challenging. Advances in the knowledge and understanding of pathophysiology and clinical presentations of neurologic disorders, aided by the considerable effect of advanced imaging technologies, are reflected in this revised edition of a classic textbook. This third edition adds more than 100 new figures, tables, helpful management algorithms, and illustrations that are based on the understanding of pathophysiology and neurologic presentation of critical illness in the ICU.

In the first of four parts, the author describes in detail general clinical neurologic problems in the ICU. Delirium and coma are common clinical states that confront intensive care physicians. With appropriate diagnosis and treatment, coma can often be treated successfully. Any delay in diagnosis and treatment can be detrimental. The author emphasizes that the clinician must determine whether the cause of impairment is structural or metabolic because diagnostic testing and treatment methods will differ accordingly.

Recent technologic improvements in computed tomography, magnetic resonance imaging, and positron emission tomography have facilitated earlier intervention. The detailed description of neurologic examination of patients in coma is outstanding. The author then describes the effect of commonly used medications in clinical practice and their neurologic manifestations, with emphasis on the pharmacokinetics and pharmacodynamics of commonly used sedatives and narcotics in critical illness. The addition of ketamine and butyrophenones to this review would have made the chapter more comprehensive, however.

Furthermore, the author describes in detail the differential diagnosis and management of seizure disorders in the ICU, with emphasis on early detection of structural lesions. For practicing intensivists, the reviews of drug-associated seizures as well as seizures associated with drug withdrawal and metabolic abnormalities provide an important resource in patient management. The author also evaluates the current knowledge of neuromuscular problems in the critically ill, peripheral neuropathy, critical illness polyneuropathy, acute motor neuropathy, neuromuscular junction dysfunction, and myopathy.

In part two, the author reviews neurologic complications of commonly performed invasive procedures in the ICU. Then he provides a detailed review of the neurologic manifestations of acute bacterial and viral infections.

In addition, the author offers practical advice on how to manage various forms of encephalopathy resulting, in the medical and surgical ICUs, from toxicity of endogenous products secondary to organ failure, with detailed reviews of liver and renal failure, endocrine dysfunction, and toxicity secondary to exogenous poisons (e.g. , sedative drugs, psychotropic drugs). He also addresses abnormalities secondary to electrolyte and acid-base disturbances. The author also provides a review of neurologic complications of hematologic disorders. The author's discussion of neurologic complications of cardiac arrest, resuscitation, and the use of therapeutic hypothermia is especially helpful.

In part three, the book describes outcomes after various neurologic complications. The review of the outcomes of medical pathology was outstanding. It is extremely important that surgical pathology and stroke be well defined for timely consultation and intervention by neurosurgical and neurology services. However, I believe this section needs more detailed criteria for critical care physicians to obtain proper imaging for thorough and timely consultation. The end of the book details the challenges of consultation in the ICU, especially end-of-life decisions, brain death, and organ donation.

In general, Neurologic Complications of Critical Illness  provides very comprehensive coverage of neurologic diseases, including reviews on virtually all critical illness with serious neurologic complication. Certain chapters of this book are written for neurologists, however, and not for medical intensive care specialists, especially the chapter on consultations in the ICU. I believe defining the indications for neurologic service consultations should provide guidelines for the timely intervention of the neurologists in the management of critically ill patients.

University of Maryland School of Medicine, Baltimore, Maryland.