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Ischemic cerebrovascular disease
  1. Louis Caplan

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    By Harold P Adams, Vladimir Hachinski, and John W Norris (Pp 575, £95.00). Published by Oxford University Press, New York, 2001. ISBN 01951-328-90

    The most recent book in the very successful “black book” Contemporary neurology series from Oxford University Press is a monograph on brain ischaemia. The book is written by three experienced and well respected North American authors—Adams from the United States and Hachinski and Norris from Canada. The present monograph is a successor to a previous book entitled The acute stroke by Hachinski and Norris published 16 years ago.

    There are now many books on stroke and on brain ischaemia. While reading this present endeavour, I continued to ponder the role of this monograph among the already burgeoning library of books. Whom is it aimed at? Who will profit most by its content? When, why, and how will readers use this book?

    The text can be conveniently divided into four parts. The initial portion consists of four chapters: an introductory general chapter followed by single survey chapters on epidemiology, clinical presentation of ischaemic and transient ischaemic strokes, and imaging and laboratory evaluation of these patients. The second portion of the book consists of five descriptive chapters: four concern different stroke aetiologies—atherosclerotic diseases, non-atherosclerotic vasculopathies, cardiac sources of embolism, and prothrombotic states; the fifth chapter considers ischaemic strokes in the young. The final five chapters discuss management: medical therapy, surgical therapy, acute management of patients with ischaemic stroke, and hospital management and rehabilitation. The management section, although consisting of only five chapters, makes up 245 pages, nearly half of the 575 pages of the book.

    The book has some attractive features that make it very user friendly. It is well organised. There is a detailed outline at the beginning of the book and at the beginning of each chapter. Furthermore, there are clear bold subheadings and a detailed index. These features make it quite easy to locate desired information. Tables are sprinkled amply throughout and the tables succinctly summarise key points. The book is very heavily referenced and the references are up to date. There are ample figures that illustrate well the main disorders and the main diagnostic tools. A unique feature is the inclusion of clear diagrams and figures of echocardiograms. Cardiac investigations are not usually covered nearly as well in monographs about stroke.

    The best and most useful portion of the book is the section on management of patients with ischaemic stroke. This was the core of the predecessor of this book. Treatment discussions are practical, detailed, evidence based, and up to date. The chapter on management of patients with acute ischaemic stroke is especially well done and will be quite useful for non-neurologists and non-stroke neurologists who lead stroke treatment in hospitals and stroke units. The chapters on clinical presentation and stroke aetiologies are less successful. Except for coverage of cardiac investigations and prothrombotic states, these chapters are rather brief and general, and serve only as introductions to the subjects discussed. In the non-management chapters, the authors seek to cover the waterfront and at least mention most things neophytes and non-stroke experts would want to look up. These non-management chapters are covered much better and in much more detail in other texts. The presentations are practical and are time locked to trials and results of treatment. There is little theoretical background or detailed discussions of anatomy, pathology, and pathophysiology. The attempt to cover all topics means that some are very scantily considered. The sections on vertebral artery disease, cerebellar infarction, and lacunar infarction are extremely brief. Many of the non-atherosclerotic conditions and cardioembolic sources are mentioned only in brief pithy paragraphs. Non-stroke experts would derive the barest information from the text but can look up references. Unfortunately, most references are only to journal articles; references to monographs and review of topics considered scantily would also have been helpful.

    This book will be most useful to non-neurologists and non-stroke specialists who have the responsibility of managing patients with acute brain ischaemia acutely in emergency rooms and in hospitals. It serves as an excellent reference source concerning a wide variety of topics related to brain ischaemia, which are considered in more detail elsewhere.