The Human Brain and Spinal Cord: Functional Neuroanatomy and Dissection Guide, 2nd ed.

Heimer L. New York, NY 10010, Springer-Verlag New York Inc, 1995, paperback, 506 pp, illus, $45.

As the title indicates, this new edition of Heimer's 1985 monograph is primarily a presentation of the anatomy of the nervous system, with discussion of the functional characteristics of major components. A major component of the text is the inclusion of discussions of the clinical relevance of the basic science information presented, through both general analysis of the effects of pathology and presentation of brief case studies.

The text is divided into four sections, each with several chapters. Section 1, the introduction, provides a general overview of the central nervous system (CNS), with an introduction to terminology and major structures; a chapter on development of the nervous system; and a chapter describing the meninges and the cerebrospinal fluid. The discussion of development in the second chapter is thorough for the prenatal to early infancy period. A very brief section on aging is included. The clinical material in this chapter addresses factors that can alter normal development.

The second section of the text provides five guided dissections, with illustrations, of the CNS. Dissection using both slice and blunt approaches are presented. The directions and illustrations are clear and thorough. Because dissection guides for the CNS are relatively difficult to come by, this section would be of particular value to the instructor who wants to encourage study of CNS structure through active exploration. No functional or clinical information is included in this section.

An atlas of the CNS is provided in the third section of the text. It has the value of pairing myelin-stained sections with magnetic resonance images of the same view. For the serious student of neuroanatomy, however, this atlas would be insufficient. The images are printed on a relatively small scale, and only major structures are labeled. The number of sections presented in each of the three planes is limited: five sagittal, seven horizontal, and eight frontal. There are no separate sections of the brain stem@ These deficiencies could, for the most part, be overcome by reference to other sections printed elsewhere in the text.

The last section of the book contains the bulk of the functional information. It is divided into 19 chapters. The first 2 chapters present histology of the nervous system and neuroanatomical techniques. The remaining chapters address the major components and functions of the nervous system in a standard progression, starting with a discussion of the spinal cord amending with discussions of neurotransmitters and CNS vasculature. A chapter on central and peripheral components of the autonomic nervous system is included. The presentation of structure at the gross, functional system, and cellular levels is excellent for an introductory text, providing sufficient information without overwhelming the reader with unnecessary detail. Functional systems are presented both from the classical perspective (eg, functional spinal cord tracts), and from the perspective of neurotransmitter-related systems (eg, various brain-stem and forebrain systems). A final appendix presents diagramatically peripheral somatic innervation using dermatome maps and muscle innervation diagrams. No spinal nerve plexuses are described.

As one might expect with a "functional neuroanatomy" text, in-depth discussion of neurophysiology is lacking. The mechanisms of neurotransmission and synaptic activity are not discussed, although synaptic structure is addressed in considerable detail. Mcchanisms of motor control are presented, but in a fairly superficial manner with no consideration of major current perspectives on motor learning. Pain, another consideration of importance to the physical therapist, is given superficial mention.

The clinical notes and cases address primarily pathology and diagnostic considerations. They might serve as a basis on which to construct case studies for a problem-oriented discussion, but they do not provide considerations of progression or response to intervention (other than, in some cases, surgical intervention).

The extensive illustrations include black-and-white CNS sections derived from various imaging techniques and two-color (gray, red) structural drawings. The illustrations are clear and presented in logical relationship to the text. The absence of full-color imaging illustrations would only concern the reader particularly interested in that area of study.

Suggested readings are provided at the end of each chapter, and a general resource list of monographs is given at the end of the book. The number of readings for each chapter is relatively small ranging from 4 to 18 per chapter) and guide the reader to major monographs or journal articles. Preference is given to publications from the decade from 1985 to the present, with only a few earlier works being cited. The absence of specific references would perhaps be frustrating to the reader looking for detailed information, but is probably of value to the new student who is still focusing on obtaining a functional overview of the subject.

The monograph could not stand alone as a text for a neuroscience course due to the mentioned deficiencies in the area of atlas and neurophysiology presentations. It would, however, provide a useful adjunct for students seeking a clear and concise initial discussion of functional and clinical neuroanatomy.

Dr Littell provides consultation to physical therapy education programs. She has authored a basic neuroscience text for physical therapists.