Neuroanatomical Basis of Clinical Neurology
Authors: Rajith De Silva
Journal: Journal of the Royal Society of Medicine (2002)

Many of today's clinical neuroscientists were attracted to the field during undergraduate training by the correlations that exist between (disordered) neuroanatomy and neurological disease. Suddenly the hours of knowledge acquisition seemed to have some point. So one might think that a book by an experienced neuroanatomist, which in its very title alludes to this association, must be a sure-fire hit. Unfortunately, Arslan misses the mark.

Arslan relishes his task, and his intention is to produce the definitive correlation between neuroanatomy and clinical neurology. In his preface he states: ‘... ideas and efforts are cohesively synthesised in this uniquely designed text that is easy to understand, yet remains a solid source of information on neuroanatomy and neurology’. It does not seem to occur to him that this task may be impossible, and that the best any text (especially one designed for medical students) can hope to achieve is to establish the few basic facts and give examples of (possible) correlations. The rest is best left to the students' imaginations surely?

The organization of the text is awkward. The morphological part of the text describes development of the nervous system, the basic constituents of the nervous system and the component parts of the central and peripheral nervous systems. The ‘functional’ part describes the sensory and motor systems. The author claims to emphasize the neuroanatomical pathways and the resulting clinical conditions in the latter section, but the important cerebellar connections (for example) are to be found in the first part. In both parts clinical correlations are included in blue-shaded text, but here Arslan displays uncharacteristic capriciousness. Conditions as varied as multiple sclerosis and pellagra are covered in a dizzy spectacle that pays no regard to relative prevalence or clinical importance. There are also statements within these areas that are plain wrong: sumatriptan is a 5-HT1B/D agonist; olivopontocerebellar atrophy is not associated with mental retardation. These areas also include hints on neurological examination, details on neurotransmitters and the make-up of cerebrospinal fluid. One gets the impression of unselective inclusion of clinically allied information alongside the neuroanatomical text. I suspect that students will end up baffled and frustrated.

The neuroanatomical descriptions are comprehensive and may be of use for revision by clinicians. Whether or not the detail is sufficient for medical students will depend on the syllabus of the medical school, and this text is presumably targeted at the Chicago college where Arslan teaches. The text is supplemented by diagrams, photographs of gross specimens and cut sections, and radiological studies, none of them of especially high standard. The anatomical line drawings are inferior to those in the classic work by Patten. Each chapter is concluded by a list of references (headed Suggested reading), some of which are entire books. Readers would have appreciated a few words from Arslan as to why he felt the recommended works should be consulted. A great deal of effort has gone into this book and it is not expensive. But the money might be better spent on joining a library or getting an Internet connection.