BOOKS - Reviews Cardiac Surgery and the Brain Edited by Peter L. Smith and K. M. Taylor London. Edward Arnold, 1993 284 p p 3 illustrated, $1 10.00

For nearly 40 years extracorporeal circulation has been used to bypass the human heart during cardiac surgery. As surgi- cal, anesthetic, and perfusion techniques have improved, mortality has dropped dramatically, raising neurological mor- bidity to paramount concern. In Cardiac Surgevy and the Brain, Drs Smith and Taylor edit a comprehensive review of this complicated literature in a readable, well-organized, multiauthored book.

The book is divided into three sections. The first section surveys the clinical impact of cardiac surgery on the brain. It begins by introducing the technique of cardiopulmonary by- pass (CPB) and the various phenomena unique to this inter- vention, including progressive vasoconstriction, flow-no re- flow, and blood cell activation. Five chapters review the incidence and prognosis of neurological sequelae including stroke, psychosis, decline in intellect, encephalopathy, and peripheral nervous system damage. The issue of prophylactic and concomitant carotid endarterectomy is reviewed in de- tail. Two chapters provide in-depth review of the numerous cognitive outcome studies spanning the last 30 years, which demonstrate a consistent decline in neuropsychiatric test scores following CPB. An additional chapter addresses the neuropsychiatric and behavioral development of pediatric pa- tients who receive headheart-lung transplants. The poten- rial neurological damage from heart transplantation and toxic- ity from immunosuppressive agents is reviewed. Finally, the technique of deep hypothermia with circulatory arrest is dis- cussed and compared with continuous low-flow bypass with emphasis on potential neurotoxicity of these procedures.

The second section surveys various techniques used to as- sess cerebral function during cardiac surgery. It begins with a review of cerebral blood flow and its measurement, a dis- cussion of the controversy around carbon dioxide manage- ment strategies, the coupling of cerebral oxygen consump- tion and blood flow, and the neuroprotective effects of hypothermia. Data using transcranial Doppler, magnetic res- onance imaging, and retinal fluorescein angiography are pre- sented in subsequent chapters, which support the contention that multiple embolizations to the cerebral vasculature occurs during CPB.

The last section reviews various neuroprotective strategies tested in humans undergoing CPB. These include the use of platelet aggregation inhibitors (prostacyclin and synthetic analogues), anesthetics (barbiturates and propofol), and the use of excitatory amino acid antagonists. The book concludes with a discussion of blood gas Sanagement strategies, arterial filtration, and type of oxygenator.

This book is potentially useful for a wide range of prac- titioners including cardiothoracic surgeons and anesthesiolo- gists. Consulting neurologists will find excellent discussions about the range, incidence, and prognosis of neurological syndromes unique to patients undergoing cardiac surgery. Similarly, cardiologists, internists, and pediatricians who refer patients may find this text informative so as to best educate

their patients and families about the risks of cardiac surgery. Finally, each chapter raises clinically important questions that are potentially answerable by the researcher interested in human neuroprotection.

Wade S. Smith, M D , PhD San Francisco, CA

Advances i n Neurology, Vol. 64: Neurological Complications of Pregnancy Edited by Owin Devinsky, Edward Feldmann, and Brian Hainline New York, Raven, 1994 272 p p p illustrated, $90.00

This book is part of the successful series on advances in neurology published by Raven Press. Like several other books in this series, the present volume is based on the pro- ceedings of a symposium-this one held in New York in 1992. Unlike many of its companion volumes, however, a general overview is provided rather than an account of re- cent advances in a particular field.

The emphasis of this book is on the diagnosis and treat- ment of neurological disorders in pregnancy. A wide range of neurological topics is discussed in 17 chapters; the remaining three chapters are concerned with psychiatric disorders, co- caine and alcohol use, and legal issues. Most chapters consist of useful and comprehensive reviews of the literature. A few of the chapters, however, provide a general account of vari- ous neurological topics with only passing reference to preg- nancy, rather than a more focused account that emphasizes issues assuming particular importance during pregnancy. In- deed, in a number of instances, a neurological disorder is discussed in some depth before the reader is informed that it has rarely, if ever, been reported in association with preg- nancy.

Nonetheless, there is little doubt that this book will serve as a valuable source of information for practitioners responsi- ble for the care of pregnant women with neurological disor- ders, and it certainly merits a place in all institutional medical libraries. Individual physicians may hesitate before purchas- ing this book, however, because of its cost and because it is relatively uncommon to encounter women with neurological disorders that pose difficult management problems related specifically to pregnancy.

Michael J . Aminoff; MD, FRCP San Francisco, C A

Brain Tumors: A Comprehensive Text Edited by Robert A. Morantz and John W . Walsh New York, Marcel Dekker, 1994 864 pp, illustrated, $195.00

This is a well-produced and nicely illustrated volume that focuses on primary brain tumors with a decidedly surgical emphasis. However, many chapters, including those dealing with epidemiology, radiology, radiation therapy, and chemo- therapy will interest medical neurooncologists as well as neu-

Copyright 0 1994 by the American Neurological Association 119