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Management of stroke: a practical guide for the prevention, evaluation and treatment of acute stroke, 2nd edition
  1. Z E Brown,
  2. M M Brown

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    Edited by Harold P Adams, Gregory J del Zoppo, and Rudiger von Kummer (Pp 303, US$24.95). Published by Professional Communications Inc, Caddo, 2002. ISBN 1-884735-517

    This textbook exemplifies the recent and dramatic changes in the approach to the management of acute stroke. Whereas in the past stroke was seen as untreatable, this book sees stroke as an emergency warranting acute treatment. As the authors state in the introduction, “A positive attitude towards stroke is critical. Patients with cerebrovascular disease should be considered to have an illness that can be treated successfully.” This admirably emphasises the approach that sees stroke not as an untreatable “cerebrovascular accident” (a term that should be expunged from medical texts) but as a “brain attack”, a term the authors use to emphasis the need for rapid diagnosis and evaluation of acute suspected stroke.

    Despite giving the impression of being a brief guide, almost all aspects of emergency stroke treatment are covered, starting with organisation of stroke services and proceeding to diagnosis and emergency treatment. There is also a chapter devoted to stroke prevention. The text is divided into 13 chapters, followed by a reference list and an index, which includes the tables and figures. The text is illustrated with computed tomography and magnetic resonance imaging scans and is interspersed throughout with very helpful summary tables. Advice is clearly given and where there is controversy, the authors do not hesitate to discuss both sides of the argument. There is an emphasis on medical care during the first few days after a stroke. Rehabilitation is quite rightly introduced as an integral part of the management of patients with stroke, but not really explored, being only allocated a few paragraphs. Hence, the book is clearly not intended to be a comprehensive guide to the totality of multidisciplinary acute stroke management.

    Measuring only 6 × 4 × 2 cm, this book is small enough to fit in a white coat pocket. This suggests that the book is designed to be carried around by the medical student, resident, or trainee on acute take. However, nowhere in the book do the authors make clear their intended audience and neither do they say whether it is intended to be a pocket sized handbook or a detailed textbook that happens to be small. Certainly the size of the book is an advantage, and the numerous tables will undoubtedly prove useful for the busy clinician or the student revising for exams. However, the lack of colour detracts from the attractiveness of the text and the binding prevents the book from opening well. It also needs a more durable cover as it will quickly become dog-eared from being frequently stuffed in and out of a pocket.

    Unusually for this type of book, the text is extensively referenced, with 688 separate references, reflecting the large evidence base behind the current rational treatment of stroke. This has the disadvantage that references after nearly every sentence tend to interrupt the flow of text, giving the impression that one is reading a list of facts. If the text is really meant to be used to guide treatment in the heat of the moment, or equally to be read at leisure to gain understanding of the topic, perhaps a recommended reading list of a few key articles at the end of each chapter might be more useful.

    The text is clearly orientated towards the North American market. For example, it is assumed that suitable patients will be treated with intravenous tissues plasminogen activator (tPA). This has not yet been licensed in most other parts of the world, but the algorithm detailing the assessment of patients with thrombolysis will prove useful elsewhere when tPA eventually receives a license outside North America. The text does deal with many other acute approaches to treatment that can be adopted without embracing thrombolysis, for example the treatment of metabolic disturbances and raised intracranial pressure. Another difficulty is that the use of some North American terms may grate slightly with those more used to other forms of English. For example, `emergent’ rather than `emergency’ is used throughout. Some North American terms such as emergency department are written in full only once, then used abbreviated (ED) throughout the book. A list of the many abbreviations would help with this problem.

    In conclusion, this is a useful book on acute stroke management, which will appeal especially to the North American market. The next edition will hopefully be more user-friendly with a better layout, improved binding, and some colour.

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