The Behavioral and Cognitive Neurology of Stroke is a very handy reference book for the bedside or brief office examination of the stroke patient. The initial chapter highlights the need for serial mental status exams during the critical initial post stroke period. The book is then organized by functional sections, each containing several chapters. The sections are organized by neuropsychological processes in the usual “walk around the brain” format. Thus, the reader is offered sections on motor and gestural disorders, aphasia and arthric disorders, hemineglect and right hemisphere syndromes, agnosia and Balint's syndrome, and executive and memory disorders. Of great significance is the inclusion of a section on behavioral and mood disorders, which reviews the clinical domains where the disciplines of psychiatry and neurology overlap. The final section, dementia and anatomical left/right syndromes, extends and integrates the previous sections.
Given the title, the reviewer had expected the sections to be organized by vascular systems, e.g., behavioral and cognitive manifestations of stroke of the anterior communicating artery. However, after the walk about the brain, there is a final chapter, Right Versus Left Hemisphere Syndromes, by Isabel P. Martins and colleagues describing the common cluster of neuropsychological findings observed with vessel-specific obstructive strokes. Most chapters are clearly written, succinct, and have the added advantage of containing several tabular sections termed “Key points” which provide a summary of the section's most salient information. Most chapters describe easy to administer, valid procedures to assess a specific neuropsychological process and contain a brief section, perhaps several paragraphs, highlighting rehabilitative or treatment programs for enhancement of the disorders discussed.
The chapters are generally well researched and well written. Each presents a succinct review of the literature, and offers what is the present common wisdom concerning the phenomenology, the underlying clinical-pathological correlations, and the treatment for each disorder. The chapter on dysarthria by Pascal Auzou is an excellent example of the ability to present a brief, 16 page, but authoritative review of a domain, including an intelligent review of the literature supporting various treatment approaches. Not all the clinical entities lend themselves well to such a tight format. The chapter on depression after stroke, by Carota and Paolucci, is perhaps the best exemplar of such difficulties. The authors struggle to reconcile psychiatry's descriptive diagnostic criteria of disorders of behavior, affect, and thought with neurology's clinical-pathological criteria for such disorders. The two diagnostic models do not allow for a simple agreement as to what constitutes a diagnosis. The authors question the psychiatric distinction between the diagnoses of depression and depression occurring with a chronic medical condition, and the distinction between endogenous versus reactive depression. These distinctions become critical as one attempts to reconcile the conflicting findings in the literature relating neuroanatomic systems and depression. The chapter contains little gems like the inclusion of scales appropriate for the assessment of depression in aphasic patients and is an excellent chapter for a brief review of a complex subject.
The chapter by Dieguez, Staub, and Bogousslavsky concerning asomatognosia was both the most interesting and least scientifically satisfying. It is among the longest chapters, 36 pages, including an appendix entitled “A funneled guideline for the bedside interview”. The authors present the reader with a diagnostic entity termed an asomatognosia which they state is “roughly defined as the disturbances of the body schema, (and) encompasses a wide array of clinical pictures under a unitary conceptual framework” (p. 215). The authors note that usually asomatognosia is viewed as a subsection of the study of anosognosia or neglect. However, they propose to return to the French tradition, that of Lhermitte (1939) and Hecaen & de Ajuriaguerra (1952) in which anosognosia was viewed as an instance of hemiasomatognosia. The authors then present a very detailed and well reasoned explication of their framework for disorders of body schema. However, the level of detail contained in the framework far outstripped the known loci of lesions causing each of the detailed phenomena. The reader is left, therefore, with a “think piece” concerning the nature and etiology of disorders of body schema with very little clinical-pathological correlative data to support the reliability and validity of the constructs. Overall, while this chapter offers the reader an impressively logical framework, the level of authoritative literature supporting the validity of the framework was well below the level offered in the other chapters.
In summary, The Behavioral and Cognitive Neurology of Stroke is an excellent source book. It is likely to be re-read many times by its owner; indeed, every time the clinician is requested to see an “interesting” patient and needs a fast review of the phenomenology, assessment procedures, neuroanatomic implication, and appropriate treatment plan for the patient he/she is about to encounter.
