Helen Whitwell ( ed.) Forensic Neuropathology Hodder Arnold , London , 2005 . 211 Pages. Price £99.00 (hardback). ISBN 0340700041 ( HB) The editor of the book states in the preface that its ‘unique aim is to highlight the difficulties that may arise in the medico-legal setting’. The editor emphasizes that neuropathologists must also consider, in addition to traumatic brain injury, cerebrovascular disease, neurotoxicology, epilepsy and other nontraumatic medical conditions. Furthermore, the editor seeks to introduce the biomechanical aspects of head injury and to provide descriptions of post mortem techniques. In the following review I will give my views upon whether the aim of the book has been fulfilled. The list of contents is admirably short and concise, including listing the contributing authors and their professional backgrounds. The authors cover a wide range of specialities within forensic (neuro)pathology, emphasizing the importance of team work. The text is very readable and separated into smaller paragraphs and subparagraphs each with their own headings, providing a systematic and good overview. The images are practically all in colour, appear sharp, with good contrast and appropriate magnification. There is a good mixture of clinicopathological and radiological images, several of which present pathology that even the more comprehensive neuropathology and forensic neuropathology books do not contain (for example, a torn frenulum, oxalate crystals in ethylene glycol poisoning, acute decompression sickness with dorsal column involvement and corpus callosum with central pallor in Marchiafava-Bignami disease). When necessary, arrows are inserted. Furthermore a wide range of educative tables (for example, brain weights, ageing of subdural haematomas, the Glasgow Coma Scale), protocols [of block sampling in, for example, sudden unexpected death in epilepsy (SUDEP), and sudden unexpected death in infancy (SUDI)] and drawings (for example, of patients with decortication or decerebration) are inserted. The legends are precise and often conveniently placed close to the referring text. The references are up to date although older references have not been excluded. Dedicating the first chapter to the anatomy of the head and neck is good repetition and enlightens the reader with several interesting forensic-related comments, for example, the risk of extensive scalp and facial bleeds from lacerations due to the fibrous nature of the scalp's fibrous aponeurotic layer (constricting the vessels) or the extensive and highly anastomotic facial arterial supply. The discussion of the term extradural instead of epidural space is interesting. A chapter discussing techniques includes many practical issues such as the internal examination of the scalp, removal of the skull, removal of the brain in newborn and young infants (including useful fixation advice). The removal of the brain and spinal cord is not described but fine references are given. Ten appendices with recommendations for block sampling (for example, in head injury, hypoxic brain damage, dementia, SUDI and SUDEP) are very good. Important information about artefacts and findings related to hospital therapy is also given. The following two chapters and a later chapter are very well illustrated, dealing with scalp, facial and gunshot injuries; adult fractures; and penetrating injuries, road traffic deaths and falls. Although most neuropathologists probably receive forensic brains without having seen the bodies, the chapter will bring important knowledge to the neuropathologist which can be used in court when giving an opinion on the neuropathology findings in relation to the circumstances of death. Neuropathologists can also gain important information from these chapters regarding nonforensic trauma cases. The following five chapters are devoted to intracranial haematomas, contusions, traumatic brain injury, brain swelling and oedema; entities that I found interesting to compare with a later chapter dealing with head injury in children of various ages. Some of the differences included the locations of extra dural haematoma (EDH), the assessment of fractures compared with naturally occurring sutures, bruises vs. birthmarks, possible underlying arachnoid cysts in paediatric subdural haematomas, and incidence, location and possible artefacts in adult vs. paediatric contusions. The chapter on traumatic brain injury raised many interesting issues. There is a description of the historicaldevelopment of the understanding of axonal injury and its clinical significance; the modern use of amyloid precursor protein (APP) and the occurrence of microglial activity in assessing the timing of axonal injury is also discussed. The authors identify pitfalls in APP positivity in nontraumatic axonal injury. A caution is given particularly when there is nodular microglial reactivity and APP immunocytochemistry in infants and young children after very short survival periods. The difficulties in distinguishing ischaemic axonal injury from traumatic axonal injury in head trauma are discussed in relation to the topographic (geographical vs. linear) distribution of the lesions. It is suggested that the pathogenesis is included in the terminology rather than use of the more general term of ‘diffuse axonal injury’. A chapter on spinal injuries provides useful definitions and various ways of classifying them, for example, stable/unstable, complete/incomplete, minor/major or based upon types of fracture such as compression, hyperextension, flexion, rotation and distraction (or a combination hereof) or related neurological impairment. Some syndromes of incomplete lesions are also described together with the important types of cervical fracture including their symptomatology and management. The macroscopic and histological illustrations are rather few but include some good images, for example, one of a Hangman's fracture. I would have found some more neuroradiological imaging of the spinal fractures and spinal cord lesions useful, although several fine drawings are available. A section on the role of underlying disease as prediposition to serious injury and osteoporotic fractures is interesting and could well be elaborated upon further in a future edition. The next chapter includes a clear and brief overview of nontraumatic neurological conditions that might be encountered in medico-legal work. I enjoyed the clinicopathological discussion of ischaemia and hypoglycaemia, with its fine tables, and the section on iatrogenic neuropathology. The following chapter provides a thorough and systematic description of alcohol-related disorders and of the pathology in cases in which there is involvement of recreational drugs or neurotoxins such a gases (for example, carbon monoxide) and heavy metals. Subsequently an account of how to collect material for toxicological investigation is given, for example, the analysis of intracranial haemorrhage, for carboxyhaemoglobin in fire deaths or for various drugs. The section of interpretation laboratory results is very useful. The clinical aspects of head injury are covered in a separate chapter. I very much enjoyed this chapter as it thoroughly described various pathologies and symptoms and their relation to the causative mechanism(s)/pathogenesis, including the difference in symptoms depending on location (for example, symptoms of an intracerebral haemorrhage when temporal, frontal or posteriorly located) and on expansion. Concepts such as concussion and the importance of the clinical impact of a second blow (the second impact syndrome), coma, persistent vegetative state (with discussion of when it is regarded as being irreversible, and with interesting comments of possible pitfalls between neurological recovery and brainstem controlled functions), locked-in syndrome (LIS) (with the explanation of why LIS patients maintain eye movements) and a clearly described definition of brain death diagnosis were all dealt with. The chapter also contains several CT scans and skull radiographs of haemorrhages and fractures, the latter with a list of possible associated cranial nerve injury. A section on the outcome of head injuries is also included. The last and excellent chapter ‘Role of the expert witness’ is devoted to the legal aspect of forensic neuropathology work. With the authors representing both the legal profession (with a Barrister/Queen's Counsel) and forensic pathology, the chapter provides a useful introduction especially to the adversarial trial system, including explanation of relevant laws and the lawful background for the use of expert witnesses. Much practical advice, with reference to real cases, is given on what to do in the pretrial period and in Court, including statements, collaboration with the other party's expert witnesses, providing both facts and opinions, not straying beyond one's field of expertise, expressing weaknesses and strengths in, for example, timing issues, mentioning whether the view is based on a hypothesis or a consensus, and refraining from arguing during cross examination. The discussion of a paper, which examines the evidence base in the literature of the ‘shaken baby syndrome’ and suggests a scale for use in analysing evidence is an interesting approach also to controversial aspects of forensic medicine. Although difficult to find suggestions for any further improvement of this book I would suggest that epilepsy be dealt with in one chapter only, as it is currently covered by smaller paragraphs in at least four chapters, creating some repetition of the information given. I also have to mention that I was slightly puzzled by the number of printing errors that are present in this first edition – Having said this I must say that this book is excellent and fully meet its aims. I particularly appreciated the continuous relation of the neuropathology findings to forensic aspects rather than ‘just’ being another neuropathology book. Many fine and relevant examples are given, and there is a critical approach to the interpretation of findings, and the emphasis on possible pitfalls together with practical examples of a legal nature. I can highly recommend this book.