Brain, Vol. 125, No. 12, 2782-2783,
December 2002
© 2002 Oxford University Press
Book Review |
ISCHEMIC CEREBROVASCULAR DISEASE
Department of Neurology, Cardiff, UK
ISCHEMIC CEREBROVASCULAR DISEASE
By H. P. Adams, V. C. Hachinski and J. W. Norris
2001. New York: Oxford University Press
Price £95. pp. 608. ISBN 0195132890.
Ischemic Cerebrovascular Disease is part of the Contemporary Neurology series. I read it over a weekend and then used it over a 3-month period to look up clinical issues which came up on the wards and in the clinic.
The book contains 14 chapters, all of which are well referenced. The contents pages allow the reader to scan the sub-headings of the text easily and quickly. After an introductory chapter the reader is guided through the epidemiology of ischaemic stroke to the presentations of stroke and transient ischaemic attack. Chapter 4 discusses the clinical evaluation of TIA and stroke patients, Chapter 5 focuses on atherosclerotic cerebrovascular disease and Chapter 6 on cardiac sources of embolism. Non-artherosclerotic vasculopathies, pro-thrombotic states and stroke in children and young adults (and genetic causes of ischaemic stroke) follow in Chapters 7–9. Chapter 10 discusses the medical therapy for the prevention of ischaemic stroke and Chapter 11 the surgical options. Chapters 12 and 13 are extensive reviews of the management of acute stroke and Chapter 14 an overview of rehabilitation and recovery. There are a number of excellent radiological images and tables.
On reading through the book there were a number of interesting sections. In the introductory chapter we are reminded of the economic implications of stroke and the large number of different services to which stroke physicians and stroke patients need access. In the discussion of the different vascular pathologies the concept of the vascular centrencephalon was helpful and one I have already used for teaching purposes. Helpful tables summarise the differential diagnosis of TIAs and the key features in differentiating them from non-ischaemic causes of transient neurological impairments. I was interested to see the diagrams describing the patterns of headache with occlusions of different intra-cranial vessels, although the sensitivity and specificity of such symptoms is not described. The clinical features of a number of different stroke syndromes including the vascular syndromes of the thalamus are well described. Chapter 4 contains a number of helpful CT and MRI images including some striking diffusion weighted images. Many non-neuroradiologists will be helped by a table summarising the changes in MRI signals in patients with recent vascular events. PET studies and SPECT studies are not accompanied by any images (there are no colour images in the book) and are discussed briefly. There is a useful discussion of magnetic resonance and CT angiography as well as traditional angiograms. The importance of adequate cardiac imaging is emphasised by an excellent overview of transthoracic and trans oesophageal echocardiography. Although the chapter devoted to atherosclerotic disease includes a number of facts and themes already referred to in earlier chapters I enjoyed the description of dolichoectasia of the basilar artery and an overview of atherosclerosis of the arch of the aorta with its description of shagbark aorta and trash toes syndrome. The chapter on non-atherosclerotic vasculopathies includes a disappointing discussion of arterial dissection without any MR imaging to accompany the carotid arteriograms and other illustrations. We are informed that MRI is helpful in diagnosing radiation angiopathy but referred to a reference for further detail. There was little discussion of the pathology of the rarer causes of cerebrovascular disease such as fibromuscular dysplasia and Buerger’s disease but a helpful overview of Moyamoya disease and Moyamoya syndrome; 38 conditions are listed as being associated with the latter. Whipple’s disease is included in this chapter as a condition which may mimic cerebral vasculitis but multiple sclerosis and other neuro-inflammatory diseases are not. The detailed chapter on the management of the acute (hyperacute) patients attests to the complexity of organising such a service and processing the patients speedily enough; undoubtedly the detail contained is necessary reading for all involved in the use of thrombolysis.
Having read the book through I felt that it was an authoritative review of certain aspects of cerebrovascular disease. However, as I used the book over a 3-month period to look up routine clinical issues I encountered some minor difficulties. Considering that all forms of intracerebral haemorrhage, all forms of venous cerebral ischaemia and the ischaemic complications of arterial and venous anomalies of the brain are excluded from the book, I expected a fuller discussion of the rarer forms of cerebrovascular disease, including more on the histopathology, biochemistry and molecular biology. I could not find a description of cerebral amyloid angiopathy and the space allotted to lacunar disease seemed small given its importance in routine clinical practice. Readers who have become accustomed to the presentational style of evidence-based medicine may struggle with the format and the layout of trial results; systematic reviews and metanalyses do not form a prominent part of the text and Forrest plots are not used.
By focusing on just some of the causes of ischaemic cerebral disease the authors may have reduced the potential of the book to provide a useful overview. Whilst I would recommend this book to all those involved in stroke medicine there are a number of competing texts which overshadow this book both in terms of the clarity and the breadth of information presented.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||