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I approach handbooks with a mixture of eagerness and dread. Some are what they purport to be, fit into the palm and are easy to use in the clinical setting, Others, however, require no little effort to lift and are clearly detailed tomes. This text fits snugly into the white coat pocket of the junior doctor and is comprehensive in its summary of the assessment and treatment of patients presenting with stroke—the authors clearly dislike the overused term “cerebrovascular accident” which they point out contributes nothing to the idea that this is a complex disorder requiring comprehensive appraisal and therapy.
The early chapters provide an extensive guide to the assessment and treatment of the “neurological patient”. Smaller sections follow on less obvious subjects such as the telephone assessment of subjects and more detailed differential diagnosis.
Opinions as to the appropriate treatment of cerebral infarction presenting early are evolving rapidly and this text takes an active line, suggesting thrombolytic therapy in line with the certain recent trials and the licensing of tPA for treatment of stroke in the United States.
Rehabilitation becomes the priority in the long term management of the stroke patient and this section is short in comparison with others. By contrast, the appendices provide detailed illustrations, disability scales, risk scales, and algorithms, although colour diagrams could have lifted the illustrations somewhat and some of the assessment forms did not copy well.
Overall, this is an extremely useful tool for the admitting doctor in the assessment and care of the patient with suspected cerebrovascular disease. It should be noted, however, that treatment options suggested are slanted towards practice in the United States making this portion of the book less helpful in the United Kingdom, where practice tends to be more conservative.
Despite this, the publication clearly and concisely fulfills its role as a handbook and should stimulate the physician into further examination of this important subject.