Book Review:Contemporary Neurology--Neurologic Complications of Cancer, Volume 45

The latest addition to the Contemporary Neurology series,devoted to the neurologic complications of cancer, is authoredsolely by Dr. Posner. Although this book has been written forboth the student and trained professional, who can quickly adaptto the definitive nature of the tables, diagrams, and clinicalapproaches, it is likely to be most appealing to the neuro-oncologicspecialist.

Written in a uniformly clear and concise fashion, the text isdivided into three parts. Part 1, entitled "General Considerations,"discusses the pathophysiology and treatment of blood-nervous systembarrier dysfunction, helping us understand the unique vulnerabilityof the central nervous system to the development of metastasesand the difficulties of subsequent treatment. The chapter on supportive-careagents and their complications reviews commonly and rarely encounteredside effects of frequently used drugs, such as glucocorticoids,and addresses controversial issues by outlining guidelines forthe use of anticonvulsants and anticoagulants.

Part 2 provides the clinician with clinical and laboratory descriptionsof the major sites of metastases. Well-written sections are complementedby radiographic and pathologic figures. Tables are used to providedetails 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 ofmetastases using surgical or radiosurgical approaches, are presentedwith "an even hand." In addition, provocative areasthat require further study are introduced. For example, the observationof the development of leptomeningeal tumor after the extirpationof cerebellar metastases leads to a discussion of the issue ofprophylactic treatment. The surgical and radiation options forthe treatment of epidural spinal cord compression and vertebralbody metastases are clearly explained, as is the issue of spinalinstability.

The book is also peppered with fascinating clinical vignettesand observations. Included is a case of a patient with acute lymphoblasticleukemia who developed coincident leptomeningeal metastases andweight gain; the possible role of hypothalamic infiltration withtumor that might have given rise to this clinical scenario isexplored.

The final section focuses on the neurologic syndromes that reflectnonmetastastic complications of cancer. Central or peripheralnervous disorders are increasingly common as a consequence ofnewer radiation approaches. The chapter on the neurotoxicity ofsurgical and diagnostic procedures offers a pragmatic approachto understanding the complications that result from a wide varietyof management techniques. The reader also is presented with astatistic of great implication; namely, that 20% of patients withsmall-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-associatedvascular disorders, central nervous system infections, metabolicand nutritional complications, and side effects of chemotherapy.

The breadth of this text is staggering. Uniquely combined arethe rewards of careful clinical observations and neuro-oncologicexperience. Subtle neurologic findings that can vastly improvethe clinician's skills at physical diagnosis are discussed.

Containing an amazing 2,907 references, the book is definitiveand likely to become the seminal work in the field. As written,it is useful for physicians who are able to make an initial clinicaldiagnosis. An expanded index might have been helpful to thosewho are less familiar with the occurrences of confusion, hallucinations,or dementia in the cancer patient. The Neurologic Complicationsof Cancer is a remarkable work--a compilation of discoveriesby a man who has made monumental contributions to the field ofneuro-oncology.