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STROKE—pathophysiology, diagnosis, and management, 4th edition
  1. P Sandercock

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    Edited by J P Mohr, Dennis W Choi, James C Grotta, Bryce Weir, Philip A Wolf. Published by Churchill Livingstone, 2004, £170.00 (hardback), pp 1546. ISBN 0-443-06600-0

    This is a major update—by a new editorial team—of a major reference book in cerebrovascular diseases. Updating such a big reference work is a huge task, and by and large the editors have succeeded in their task. They have assembled many very distinguished authors and put together a pretty comprehensive reference work. The early chapters on epidemiology, clinical manifestations, and underlying causes provide a very broad and detailed coverage. There is even a chapter devoted solely to infarcts of the anterior coroidal artery! The chapters are well written and heavily referenced. There are plenty of illustrations (the chapter by Bousser on cerebral venous disease has particularly good illustrations that are clearly annotated).

    However, in some of the other early chapters the selected scans and angiograms have not been done on state-of-the-art technology. I accept that of course to find a scan to illustrate a particular and unusual problem is not always easy (particularly not a recent one!). In view of this, it would have been preferable for some of the figures to have more arrows and annotations to point out exactly what the abnormality was. It would be preferable to replace the unsubtracted angiograms with subtracted films.

    The chapters on management and treatment are comprehensive, and cover all of the options that are currently in use. Thus, one can find useful material on everything from the treatment of hyperacute ischaemic stroke, to the use of neuro-interventional treatments for arteriovenous malformations (AVMs), arterial dissections, and vascular stenosis in the blood supply to the brain. Thus there is good coverage of what can be done but it is not always clear what should be done. By this I mean that the best evidence on the choice of treatment—balancing its harms and benefits—comes from randomised controlled trials and systematic reviews of such trials. In general, the authors in the book have tended to discuss each trial in considerable detail, mentioning relevant systematic reviews relatively infrequently and it is often quite difficult to extract from this mass of detail what the overall message should be. So, this book will appeal to the thoughtful, methodical reader who wishes to assess the evidence in very great detail but the “reader in a hurry” may find it difficult to locate the text that gives the final verdict on a particular treatment.

    Producing reference works of this size is a huge challenge and the authors and editors must be congratulated in bringing it to fruition. Unfortunately such large beasts have long gestations and I suspect that many of the manuscripts were submitted some time in 2002, to achieve a 2004 publication date. The editors themselves recognise this in their introduction:

    “We even hope that the information contained in this edition makes for its rapid obsolescence, so great are our aspirations for continued rapid development in our field”.

    In many ways it is good news that the authors’ predictions have been proven, since for example, the International Subarachnoid Aneurysm Trial (ISAT)—published in 2002—has clearly shown that for patients with ruptured intracranial aneurysms, coiling with detachable platinum coils leads to a substantial reduction in death or disability, compared with conventional neurosurgical clipping. It appeared too late to be included in the book. The pace of change in change in stroke is indeed rapid!

    So, this fourth edition is a welcome update to a well known reference book. The dense text and heavy referencing (e.g. the 50 page chapter on intracerebral haemorrhage has 390 references), mean that it is a mine of information, but in the very nature of such books, not always light reading.

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