THE NEUROLOGICAL EXAMINATION OF THE CHILD WITH MINOR NERVOUS DYSFUNCTION

Abstract

Ultrasonic encephalography has a limited place in the diagnostic armamentarium of a neurological department.Its potential role in detection of midline shifts in head injuries and for screening patients who might require to be sent long distances for specialist advice has led to its increasing use in peripheral hospitals.Unfortunately, it is apparent from this careful study that these are the very circumstances which are likely to predispose to false results.Professor White has produced an excellent book which should be studied carefully by anyone using the technique.The chapters on elementary acoustics, the interactions of ultrasonic energy at interfaces and their imaging, the artefacts introduced by receiving systems, and the acoustical properties of the skull are essential reading.These are followed by a careful analysis of A-mode encephalography with a valuable study of the bias introduced by the operator.Specialized methods to reduce bias in midline echo detection are then discussed and the special problems of reflection from other surfaces such as cerebral tumours, hydrocephalic ventricles, etc.The book closes with chapters on B-mode display, indicating why it has been disappointing and is likely to remain so, and on advanced techniques such as acoustical holography, intracranial echo pulsations, Doppler and contrast techniques.It may be hoped that these new methods may make it easier to standardize technique and to recognize the source of an echo, but the acoustical properties of the skull will always remain a major limiting factor.This is an excellent book which should be required reading for those using echo encephalography.