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Plum and Posner's Diagnosis and Treatment of Stupor and Coma, 5th
edition, is a major update of the classic work on diagnosing the
cause of coma, with the addition of completely new sections on
treatment of comatose patients, by Dr. Jan Claassen, the Director
of the Neuro-ICU at Columbia New York Presbyterian Hospital. The
first chapter of the book provides an up-to-date review on the
brain mechanisms that maintain a conscious state in humans, and how
lesions that damage these mechanisms cause loss of consciousness or
coma. The second chapter reviews the neurological examination of
the comatose patient, which provides the basis for determining
whether the patient is suffering from a structural brain injury
causing the coma, or from a metabolic disorder of consciousness.
The third and fourth chapters review the pathophysiology of
structural lesions causing coma, and the specific disease states
that result in coma. Chapter five is a comprehensive treatment of
the many causes of metabolic coma. Chapter 6 review psychiatric
causes of unresponsiveness and how to identify and treat them.
Chapters 7 and 8 review the overall emergency treatment of comatose
patients, followed by the treatment of specific causes of coma.
Chapter 9 examines the long term outcomes of coma, including the
minimally conscious state and the persistent vegetative state, and
how they can be distinguished, and their implications for eventual
useful recovery. Chapter 10 reviews the topic of brain death and
the standards for examination of a patient that are required to
make the determination of brain death. The final chapter 11 is by
J.J. Fins, a medical ethicist who was invited by the other authors
to write an essay on the ethics of diagnosis and treatment of
patients who, by definition, have no way to approve of or
communicate about their wishes. While providing detailed background
for neurological and neurosurgical specialists, the practical
nature of the material in this book has found its greatest use
among Internists, Emergency Medicine, and Intensive Care
specialists, who deal with comatose patients frequently, but who
may not have had extensive neurological training.
Paraneoplastic syndromes, defined in this book as "disorders caused
by cancer, but not a direct result of cancer invasion of the
affected organ or tissue", once believed to be rare and esoteric
neurologic disorders have assumed increasing importance as an
explanation of neurologic and other symptoms in patients suffered
from occult or controllable cancers. This book attempts a
comprehensive review of paraneoplastic syndromes from considering
both clinical and pathophysiologic aspects. The book is divided
into 4 sections: The first is an overview, classifying the
disorders, describing a clinical approach to the diagnosis and
treatment of paraneoplastic syndromes in general and identifying
their pathogenesis. The second section discusses the clinical
findings and treatment of individual paraneoplastic syndromes with
chapters dedicated to each of the neurologic syndromes and a
chapter discussing nonneurologic syndromes such as endocrine,
cutaneous, and rheumatologic paraneoplastic disorders. The third
section discusses autoantibodies that characterize individual
paraneoplastic syndromes. The final section discusses the
paraneoplastic syndromes associated with individual cancers.
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