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Hypothermia and cerebral ischaemia—mechanisms and cerebral ischemia
  1. A J Strong

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    Edited by Carolina M Maier and Gary K Steinberg. Published by The Humana Press, New Jersey, 2003, £99.50 (hardback), pp 177. ISBN 0-86903-660-X

    The idea that the evolution of acute brain injury can be reversed either by reducing cerebral metabolic rate or arresting metabolic pathways that determine irreversibility is one of the central concepts of acute neuroprotection. Induction of hypothermia has for many years been an attractive means of achieving this, particularly in the absence of any widely practicable and proven pharmacological treatment. This book, with a largely North American authorship and contributions from Germany and Japan, comprises 10 chapters that address experimental and clinical studies of mild hypothermia (reductions of 2 to 5° below normal brain temperature) in global and focal cerebral ischaemia, and in traumatic brain injury. Much useful scientific information is assembled. For example, in discussing experimental cerebral ischaemia, Maier makes the point that hypothermic neuroprotection is unlikely to derive purely from reductions in metabolic rate. Issues such as ion and membrane stability, excitatory amino acid release, gene expression cascades, and apoptosis are covered by several authors in the different areas of global and focal ischaemia and trauma. The message in each case is rather similar. The chapter by Schwab and Hacke, describing their experience in the clinical management of patients with stroke, is essential reading for any neuro-intensivist considering using hypothermia.

    Although the design of the book inevitably entails a certain amount of duplication, all the information is there. There is a good index and this book will be a useful source of information and advice for neuroclinicians, as well as their basic science collaborators. It should be on the library shelves of any intensive care unit treating patients with acute brain injury, and is essential reading for any investigator entering this specific field.

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