What an amazing game - graphically it's spot on, with an amazing opening scene (visually) and strong visuals throughout. Even on lower settings it still looks great. Enemies are by far the scariest and well thought out in ANY game and shooting arms and legs off is loads more fun than standard old head shots. Play this game in the dark on your own and you have a serious recipie for wetting yourself. It's unbelievably atmospheric and the music is perfect. The boss fights can be intense and after certain parts of the game, you just have to just sit back and have a break from the utter madness and intensity. There's so much originality in this game, from the environments to the general gameplay. The game flows really well without cut scenes, and the story is really clever. It's delightfully gory and messy at time, climbing over a pile of pieces of necromorphs that you've just cut to pieces. I also love the various deaths scenes of isaac, again a very good addition that many games don't have.
Overall, this is a truly terrifying and incredible game; certainly my all time favourite, and the greatest of the horror genre of all time I would say. If I was Isaac, I definately would've shot myself in the face at the very start... it's just so damn intense!