The latest addition to the Contemporary Neurology series, devoted to the neurologic complications of cancer, is authored solely by Dr. Posner. Although this book has been written for both the student and trained professional, who can quickly adapt to the definitive nature of the tables, diagrams, and clinical approaches, it is likely to be most appealing to the neuro-oncologic specialist.
Written in a uniformly clear and concise fashion, the text is divided into three parts. Part 1, entitled "General Considerations," discusses the pathophysiology and treatment of blood-nervous system barrier dysfunction, helping us understand the unique vulnerability of the central nervous system to the development of metastases and the difficulties of subsequent treatment. The chapter on supportive-care agents and their complications reviews commonly and rarely encountered side effects of frequently used drugs, such as glucocorticoids, and addresses controversial issues by outlining guidelines for the use of anticonvulsants and anticoagulants.
Part 2 provides the clinician with clinical and laboratory descriptions of the major sites of metastases. Well-written sections are complemented by radiographic and pathologic figures. Tables are used to provide details of presentations and therapies of parenchymal brain metastases, epidural spinal cancers, malignant infiltrations of the leptomeninges, and peripheral nerves.
Therapies that are subject to debate, such as the treatment of metastases using surgical or radiosurgical approaches, are presented with "an even hand." In addition, provocative areas that require further study are introduced. For example, the observation of the development of leptomeningeal tumor after the extirpation of cerebellar metastases leads to a discussion of the issue of prophylactic treatment. The surgical and radiation options for the treatment of epidural spinal cord compression and vertebral body metastases are clearly explained, as is the issue of spinal instability.
The book is also peppered with fascinating clinical vignettes and observations. Included is a case of a patient with acute lymphoblastic leukemia who developed coincident leptomeningeal metastases and weight gain; the possible role of hypothalamic infiltration with tumor that might have given rise to this clinical scenario is explored.
The final section focuses on the neurologic syndromes that reflect nonmetastastic complications of cancer. Central or peripheral nervous disorders are increasingly common as a consequence of newer radiation approaches. The chapter on the neurotoxicity of surgical and diagnostic procedures offers a pragmatic approach to understanding the complications that result from a wide variety of management techniques. The reader also is presented with a statistic of great implication; namely, that 20% of patients with small-cell lung cancer harbor the anti-Hu antibody, which is associated, in a smaller proportion, with memory or sensory disturbances. Similarly provocative are the discussions of cancer-associated vascular disorders, central nervous system infections, metabolic and nutritional complications, and side effects of chemotherapy.
The breadth of this text is staggering. Uniquely combined are the rewards of careful clinical observations and neuro-oncologic experience. Subtle neurologic findings that can vastly improve the clinician's skills at physical diagnosis are discussed.
Containing an amazing 2,907 references, the book is definitive and likely to become the seminal work in the field. As written, it is useful for physicians who are able to make an initial clinical diagnosis. An expanded index might have been helpful to those who are less familiar with the occurrences of confusion, hallucinations, or dementia in the cancer patient. The Neurologic Complications of Cancer is a remarkable work--a compilation of discoveries by a man who has made monumental contributions to the field of neuro-oncology.