This work is a dialogue. It could be between two colleagues from different disciplines, between a resident or fellow with a mentor, or between two neurointensivists trying to work through a challenging patient care dilemma. But, in any event, it is a dialogue.
Each chapter considers a case vignette or small number of vignettes. The patients presented illustrate the typical, common problems encountered in a NeuroICU. The vignettes are broken up and interspersed with the sort of discussions that occur every day in such a unit. In all cases, the discussion begins by establishing priority. What's the goal at this stage? What must we do now, to get to the next stage? The answers are as clear as the questions. Then, what else should we be thinking about? Question after question, answer after answer, the same straightforward dialogue occurs. What next? What is happening to the patient? What should we do about it? Why? Each question elicits a clear, practical response. The answer is supported by selected, pertinent evidence. Evidence is not presented as a mere list of data but rather as integrated information. The key data are explicitly stated but then there is also commentary based on subsequent studies and the subsequent collective experience of its accomplished authors. In other words, this is a dialogue. And finally, at the end of each section, as if asking "Still unsure how to proceed?", the answer comes back "Well let me tell you how we do it" and a step-by-step protocol follows.
This occurs over and over again, subject after subject and organ after organ. For this, work is not just about intensive care of the nervous system, it acknowledges and addresses all of the multiorgan problems that attend the complex diseases that can produce catastrophic injury of the nervous system.
This book is sure to be a favorite for many years to come. It is not a volume that will sit on an office shelf; it will live out in the ICU or the ED. One can only hope that the binding and pages are sturdy enough to handle the usage.
George C. Newman, MD, PhD