Brain, Vol. 125, No. 4, 923-924,
April 2002
© 2002 Guarantors of Brain
Book Review |
STROKE SYNDROMES, 2ND EDN, and UNCOMMON CAUSES OF STROKE
Department of Clinical Neurology, Radcliffe Infirmary, Oxford OX2 6HE, UK
STROKE SYNDROMES, 2ND EDN, and UNCOMMON CAUSES OF STROKE
Edited by Julien Bogousslavsky and Louis Caplan.
2001. Cambridge: Cambridge University Press.
Two volume boxed set, Price £240. Pp. 1075. ISBN 0-521-80258-X..
Stroke medicine can be straightforward, but is often complex and demanding. This is particularly true of diagnosis—whether clinical, pathological or aetiological. Cerebral infarction, for example, is much more complex than myocardial infarction. Acute coronary syndromes are almost invariably due to fissuring or rupture of a coronary artery plaque, with a limited number of possible clinical presentations, whereas stroke is an extremely heterogeneous syndrome with a multitude of clinical manifestations and underlying pathologies. Accurate clinical, anatomical and pathological diagnosis is essential to the appropriate management of stroke. This requires a detailed knowledge of neurovascular anatomy, pathology and the varied clinical presentations and consequences of stroke. Stroke Syndromes and Uncommon Causes of Stroke together provide the necessary information.
The first edition of Stroke Syndromes, published in 1995, had three sections, including one on uncommon causes of stroke, in a single volume. The separation of this third section into another volume in the second edition is welcome, and partly reflects the additions that have been made to all three sections. Stroke Syndromes covers the clinical presentation and consequences of stroke, both from the standpoint of individual clinical symptoms and signs (Part I: Clinical manifestations), and from the standpoint of the many vascular anatomical syndromes (Part II: Vascular topographic syndromes). The companion volume reviews ‘uncommon’ causes of stroke. Both volumes are essential reference texts for anybody with a clinical interest in stroke, and for any neurologist who wishes to have a detailed understanding of this most common brain disorder.
Bogousslavsky and Caplan are the acknowledged world authorities on clinico-anatomical correlation of stroke syndromes, and have both published widely on this and many other aspects of stroke. They are meticulous observers of clinical detail, and Stroke Syndromes is an important contribution to descriptive neurology. Several decades into the age of molecular medicine, most clinical practice is still, and will continue to be, based mainly on pattern recognition. Stroke Syndromes is unashamedly descriptive, and this is its main strength. It will be very easy for a busy clinician to dip quickly in and out of this book and extract important clinical information. Important because the symptoms and signs of a stroke often provide clues to the underlying pathology and hence the most appropriate management.
The editors have each written several of the chapters themselves, and have contributed much more to the two volumes than is usually expected of editors of multi-author text books. Stroke Syndromes in particular has clearly been a labour of love. The editors have put together a very impressive group of authors for other chapters in both volumes. The result is a distillation of the knowledge and clinical experience of a significant proportion of the world’s leading stroke physicians. It is particularly good to see that European and North American expertise are equally well represented, and that there are several authors from other parts of the world.
Stroke Syndromes concentrates on the clinical manifestations of stroke and does not aim to review the practical issues relating to investigation and treatment. It is therefore an excellent companion to Charles Warlow’s Stroke: A Practical Guide to Management (Blackwell Science, 2nd Edn, 2001), which concentrates mainly on practical aspects of investigation, treatment and rehabilitation. Uncommon Causes of Stroke covers all aspects of clinical presentation, pathology, diagnosis and management of the rare causes of stroke in more detail than the Warlow book. Overall, there is little of importance in stroke medicine that is not covered by at least one of these three volumes.
Stroke Syndromes and Uncommon Causes of Stroke are both well indexed, and the vast majority of chapters in both volumes are well referenced and up-to-date. However, care must be taken, particularly when consulting the index of Stroke Syndromes, not to find oneself side-tracked by the multitude of intriguing eponymous syndromes. On looking for foramen ovale I soon found myself looking up the adjacent entries on Foix–Alajouanine syndrome, Foix–Chavany–Marie syndrome and Fregoli syndrome. However, Stroke Syndromes is much more than simply an aid to ‘neurological one-upmanship’. It will be of use to any physician who is involved in the care of patients with stroke and who is interested in knowing the mechanisms of his or her patient’s problems.
Uncommon Causes of Stroke will be of interest to the generalist as well as the neurologist. There are reviews of stroke associated with specific systemic disorders, with individual chapters on systemic lupus erythematosus, inflammatory bowel disease and Behcet’s disease, for example, as well as chapters on stroke due to non-specific disorders, such as coagulopathy, hyperviscocity, paraneoplastic conditions, metabolic disorders and nephrotic syndrome. Inevitably, some chapters deal with conditions, such as Eales retinopathy, Kohlmeier–Degos disease and Sweet’s syndrome, which are considerably less common than others, such as temporal arteritis and arterial dissections, but the clinical importance of the various conditions is generally reflected in the length of the chapters.
Both volumes are well illustrated, particularly Stroke Syndromes, which has over 1000 figures. The series of illustrations in the chapter on arterial territories of the human brain are especially detailed and well produced. The quality of the many CT and MRI brain images and angiographic images is generally excellent, and goes a long way to justifying the price of the books.
It is difficult to find any major faults with these books. They are not cheap (£240 for the set), but then there is no competition. They do perhaps over-emphasize the uncommon clinical presentations and causes of stroke, but then that is the niche that they intend to fill, and uncommon is relative. Uncommon causes of stroke, the world’s most common cause of disability and second most common cause of death, will probably be seen much more often in clinical practice than many better ‘publicized’ neurological disorders, such as variant CJD or familial motor neurone disease. Moreover, although many of the conditions covered in Uncommon Causes of Stroke are rare in themselves, taken together the 49 chapters probably cover the causes of up to 10–15% of all stroke, and perhaps up to 40% of ‘young’ stroke.
In summary, these volumes are the most comprehensive and authoritative texts available on the clinical manifestations of stroke and unusual causes of stroke. They are a pleasure to read simply for interest, but will also be invaluable aids to clinical practice, and are likely to be the standard reference texts on these subjects for many years.
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