Book Review

Intracerebral Hemorrhage

Intracerebral Hemorrhage

N Engl J Med 1994; 331:1596-1597December 8, 1994

Article

Intracerebral Hemorrhage
Edited by Edward Feldmann. 348 pp. Armonk, N.Y., Futura, 1994. $65. ISBN: 0-87993-575-8

Intracerebral Hemorrhage
Edited by Carlos A. Kase and Louis R. Caplan. 516 pp. Boston, Butterworth-Heinemann, 1994. $135. ISBN: 0-7506-9308-8

It is truly unfortunate that two books, titled identically but approaching the subject of intracerebral hemorrhage from two different perspectives, have appeared at nearly the same time. They are likely to compete for the same readership, when in fact both are worthy of consideration.

The book edited by Feldmann is a multiauthored textbook with contributions from many neurologic experts from around the United States. The majority of the chapters deal with the pathology and pathophysiology of the expanding list of causes of intracerebral hemorrhage. A single chapter summarizes the clinical syndromes defined by the locations of the hemorrhages. One chapter is allotted to guidelines for medical management, and one to surgical management.

Highlights here include the discussion of the laboratory evaluation of patients with intracerebral hemorrhage. This chapter presents a detailed, rational, and systematic approach that relies on modern technology and is clinically practical. The chapters on drug abuse and thrombolytic therapy also deserve mention because of the increasing effect of these factors on the epidemiology of intracerebral hemorrhage.

As might be expected with any multiauthored work, the inconsistency in writing style from chapter to chapter, along with the inevitable redundancy, is a bit distracting. A neurosurgical perspective is also notably lacking. The chapter on thrombolytic agents, though comprehensive, contains far too many references -- so many that on some lines of text there were only two or three words, with the remainder of the space consumed by superscripts.

Despite these modest shortcomings, Feldmann's book accomplishes its goal of providing practicing neurologists, neurologists in training, and critical care specialists with an easily readable and digestible book on human intracerebral hemorrhage.

Kase and Caplan's book approaches the subject from a more phenomenologic viewpoint. Eight of the 22 chapters present detailed descriptions of the clinical findings in patients with hemorrhages in various locations in the brain. Although there are seven additional contributing authors, most of the book was written by one or the other of the coeditors. This is entirely appropriate, since each has contributed substantially to our knowledge of intracerebral hemorrhage. Both have elegant and readable writing styles. More important, their lifelong, passionate interest in intracerebral hemorrhage is conveyed to the reader in an engaging and highly informative way.

The book begins with an entertaining romp through the historical development of medical concepts of intracerebral hemorrhage, beginning with Hippocrates and culminating with the data banks and population-based epidemiology of the past decade. An authoritative chapter on the epidemiology of intracerebral hemorrhage follows. Chapters on selected pathological aspects and neuroimaging precede a section devoted to the common causes of intracerebral hemorrhage. Then come several chapters devoted to neurologic descriptions, and finally a single chapter on prognosis and treatment. Many high-quality prints illustrate the book.

There is little to quibble with in this book. The non-neurologist might find the detailed clinical descriptions arcane in this era of widely available neuroimaging. However, for the student of cerebral function, this compilation provides, all in one place, a highly readable summary of brain localization.

Perhaps the most disappointing aspect of each of these books results from the primitive state of our knowledge of the treatment of intracerebral hemorrhage. Recommendations on even the most fundamental aspects of management, such as blood-pressure control, cannot be made with authority, since, as Caplan notes, “The only feature of intracerebral hemorrhage that has not been systematically studied has been treatment.” Perhaps in the near future, patients with intracerebral hemorrhage will benefit from treatments whose value has been proved by well-designed, controlled clinical trials, as has been the case in studies of stroke.

E. Clarke Haley, Jr., M.D.
Virginia Neurological Institute, Charlottesville, VA 22908