In Context

878 www.thelancet.com/neurology Vol 10 October 2011

Me, myself, and I

Cerebral microbleeds are thought to occur as blood leaks through the walls of damaged small vessels, leading to haemosiderin deposits in brain tissue. Although these microscopically small foci of haemorrhage have been known by pathologists for many decades, the means to image them non-invasively and during life only became available in the mid-1990s through the development of MRI techniques that are sensitive to blood products. With advances in imaging, microbleeds have been detected in ever-increasing numbers of patients with neurological diseases, but also in almost a quarter of healthy people over the age of 60 years.

The exact prognostic implications of microbleeds have not yet been unravelled, but the fact that they are strongly linked to both stroke and dementia makes microbleeds of interest to a broad scientifi c and clinical community. Accordingly, the number of reports about cerebral microbleeds has increased steeply over the past few years, with more than 150 papers published from 2009 to 2011. It is therefore timely to bring all sources of information together in a single volume to summarise current knowledge, and controversies, in the fi eld.

Cerebral Microbleeds: Pathophysiology to Clinical Practice is a 198-page textbook that covers the entire current state of knowledge on microbleeds, ranging from the historical perspective to current imaging methods and histopathology, and from the population perspective to the relationship between microbleeds and specifi c diseases and symptoms.

As is often the case with books that are a collection of contributions by various authors, style and quality vary and there is a fair amount of overlap between chapters. Some chapters merely summarise results reported so far, whereas others—eg, the chapter on the role of microbleeds in Alzheimer’s disease—pose interesting new hypotheses. Yet, David Werring has succeeded in assembling virtually all authorities on cerebral microbleeds to share their knowledge and views on this emerging topic. This has yielded a comprehensive overview that is of interest both to the uninitiated student wanting to know what all the fuss is about and to the more experienced neuroscientist working in the fi eld of cerebral small vessel disease.

As for clinicians, they should not expect a cookbook that tells them how to manage their patients with cerebral microbleeds, simply because there are, as yet, no practical guidelines on treatment decisions. However, in view of the growing belief that microbleeds will play a key part in increasing our understanding of small vessel disease, and might even provide the missing link between cerebrovascular disease and neurodegeneration, practicing neurologists might well want to inform themselves of new developments in this area. To quote Vladimir Hachinski, “It is clear that we have much to learn about what, until recently, we could not see”.

Meike W Vernooijm.vernooij@erasmusmc.nl

BooksTiny brain haemorrhages in the spotlight

Ever been caught having an argument with yourself, or wondered who decided that you should move your arm just so to steer the car out of danger, or how the tennis players at competition level can return a serve speeding towards them faster than they have time to see it? Incognito sets out to discuss the how, what, and why of neuroscience, looking into the conscious and the unconscious thought processes that rule our every waking and sleeping moment. Rather than simply being a textbook of facts and historic events about neuroscience, David Eagleman lays the information out as a sequence of events, delving deeper and deeper into the human brain as we know it (and do not know it), with mind games along the way to back up his theory, along with historical facts and astounding statistics.

Some of the anecdotes and research might already be known to you, if you have ever delved into the subject

of neuroscience. But he brings us right up to date in the latter part of the book with his beliefs about criminal behaviour and the justice system. Eagleman explores new ways of addressing how we could sentence criminals and choose the appropriate punishments by using knowledge of their brains and how rehabilitation could be customised to suit the criminal. He also addresses the dark side of that knowledge though, reminding us of the dangers of allowing governments access to our innermost neuronal workings, and aptly discusses experiments in the past such as those of Egas Moniz, who was awarded the Nobel prize in 1949 for his work on lobotomising criminals to reduce them to shadows of their former selves.

I found myself hooked; indeed my brain was racing through certain sections, but a couple of times I struggled to maintain my concentration, because the

Cerebral Microbleeds: Pathophysiology to Clinical

PracticeEdited by David J Werring

Cambridge University Press, 2011.

Pp 198. £60.ISBN 978-0-521-19845-5

Incognito: The Secret Lives of the Brain

David Eagleman. Canongate Books

Pp 224. £20.ISBN 978 I 84767 938 3

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highly descriptive narrative could seem overzealous and repetitive. However, I thoroughly enjoyed reading the book, and often found the factual content so fascinating I had to take a break from the text to go and discuss my new found knowledge with the nearest person available—it is a real “did you know that...?” kind of book packed with many interesting facts for both

the established brain scientist and the reader with no scientifi c background. I would recommend it to anyone; your brain, your conscious mind, and your subconscious will all enjoy it.

Emma Hillemmahill@doctors.org.uk

Caring about caringThe slowly unfolding crisis at the Southern Cross chain of care homes in the UK has been a constant, dismal reminder of something that social and political institutions throughout the developed world are fi nding diffi cult to come to terms with—an ageing population in which almost everyone will care for someone elderly or need to be cared for themselves. According to Care UK, the work of carers contributes £87 billion to the UK economy each year, but for all their obvious worth, the voices of carers are seldom heard. That is some thing Marrianne Talbot’s book Keeping Mum hopes to change.

Talbot cared for both of her parents at the end of their lives—fi rst her father after he had a stroke, then later her mother, who had Alzheimer’s disease. The book is Talbot’s account of caring for and living with her mother during the fi nal 5 years of her mother’s life, and draws heavily on the weekly, clearly cathartic, blog that Talbot wrote throughout.

All the dealings with an overbearing bureaucracy, the frustration, isolation, and spitting rows with other family members that you might think are part and parcel of caring for someone disabled or elderly are there in spades in Keeping Mum, but a misery memoir it is not. Talbot’s sometimes brutal honesty about the agony and helplessness she often felt are balanced by

the verve and humour with which she enthuses about her and her mother’s many triumphs, and the immense sense of satisfaction she found in caring for someone she loved.

Talbot is unfl inching in her commitment to lay bare the complexity of her often confl icted feelings towards her mother and her situation. Such insights make this a fascinating book in its own right, but the bite-sized chunks of advice at the end of each entry should be enough to have it distributed free to every carer in the land. That is not to say the book is without its faults. The direct port from blog to book has the advantage of creating something perfect for dipping in and out of, but a judicious edit would have made it a more appealing cover-to-cover read. That aside, Talbot’s candor and lightness of style make it impossible to begrudge her even the occasional lapse into Sunday supplement smugness when describing the odd social set piece. Keeping Mum manages to be poignant and practical, harrowing and humorous, and Talbot’s is a voice that demands to be heard.

David Holmesdavid.holmes@zoho.com

Keeping MumMarianne Talbot. Hay House UK, 2011. Pp 304. £8·99.ISBN 9781848502918