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Subcortical stroke, 2nd edition
  1. Cathie Sudlow

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    Edited by Geoffrey Donnan, Bo Norrving, John Bamford, and Julien Bogousslavsky (Pp 450, £79.50). Published by Oxford University Press, New York, 2002. ISBN 0-19-263-157-8

    This book is a must read for clinicians and researchers with an interest in stroke. The four editors are all specialist stroke clinicians who have been thinking about and leading research in subcortical stroke for many years, and they have put together a well constructed and comprehensive multiauthor work. This second edition is longer and more extensive than the first, reflecting the considerable and rapid advances in our understanding of subcortical strokes in recent years, and in particular the increasingly sophisticated neuroimaging techniques. Given the large number of contributors, consistency of style and approach is limited, but this is more than made up for by the breadth of expertise and opinion.

    There are some particular strengths. These include the editors’ short chapter providing a summary classification of subcortical infarcts, which is best appreciated if read both before and after tackling most of the other chapters. The excellent chapter on pathology of lacunar infarction is a welcome addition to this edition, while the chapters discussing risk factors and prognosis provide very useful commentaries and summary tables of all the relevant studies. The discussion around the usefulness (or not) of clinical diagnosis of lacunar syndromes, carefully updated with the information from recent clinicoradiological studies, is both thoughtful and logical, with plenty of clinical and epidemiological common sense.

    In common with all recently published medical textbooks, this one is already a little out of date. This is most noticeable for the chapter on therapy, where recent advances (for example, new evidence on blood pressure lowering from the PROGRESS trial and on cholesterol reduction with a statin from the Heart Protection Study) are likely to have most impact on clinical practice. If the editors have the energy to produce a third edition, there is (as always) some room for improvement. The series of chapters on infarcts in specific subcortical territories would be enhanced by some figures illustrating the vascular anatomy that is discussed in the text. In addition, the quality of the discussion of study methodology varies considerably between chapters, and some would benefit from a more systematic and accurate approach to statistical and epidemiological concepts.

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