Book Review

Cerebrovascular Disease

N Engl J Med 1998; 338:1079-1080April 9, 1998

Article

Cerebrovascular Disease
Edited by H. Hunt Batjer, with Louis R. Caplan, Lars Friberg, Ralph G. Greenlee, Jr., Thomas A. Kopitnik, Jr., and William L. Young. 1276 pp., illustrated. Philadelphia, Lippincott–Raven, 1997. $275. ISBN: 0-397-51661-4

Recent years have seen a surge in publications of all sorts in the field of cerebrovascular disease: research papers, reviews, and textbooks. Driving this activity is the burst of new information about the mechanisms underlying ischemic or hemorrhagic brain damage and the consequent rapid development of new diagnostic and therapeutic modalities. In a manner comparable to the revolution in the treatment of acute myocardial infarction that occurred in the 1980s, the clinical approach to stroke is now evolving from passive acceptance to active management, which encompasses both prophylactic risk reduction and acute care interventions such as thrombolysis and neuroprotection.

This ambitious book may be the largest clinical textbook yet on the topic of cerebrovascular diseases; 1276 large-format pages put it squarely in the bookshelf (vs. briefcase) weight class. But the power-to-weight ratio is good; its considerable displacement carries a wealth of valuable knowledge from leading scholars in many disciplines and from all around the world. The book contains 100 chapters, organized into five major sections: the cerebral vasculature in health and disease, cerebrovascular diagnosis, ischemic stroke, hemorrhagic stroke, and socioeconomic and ethical issues. Coverage is quite comprehensive, with an emphasis on the cerebral vasculature and especially strong coverage of topics relevant to neurosurgical management, such as carotid endarterectomy, vascular malformations, intracranial aneurysms, subarachnoid hemorrhage, and trauma. The chapters are well illustrated, especially with radiologic images and surgical schematics, and they are also generously supplied with references, many chapters containing 30 to 50 citations and some reference lists approaching 100 citations. Since papers published as recently as 1995 are cited, many of the chapters serve as minireviews providing good access to the primary literature. The last section (five chapters), on socioeconomic and ethical issues, is a distinctive plus; although brief, it provides a bird's-eye view of the landscape of cerebrovascular-disease care that will interest all clinicians who treat patients who have had strokes. A minor weakness is the occasional odd grouping of chapters into sections; for example, a basic science–oriented chapter on gene therapy and a chapter on neurologic recovery are embedded in the initial section on the cerebral vasculature; or in the second section, the chapters discussing the general management of brain ischemia, including that due to carotid occlusion, are placed under the specific subheading of intracranial vascular disease.

Overall, the book stands up well in comparison with the leading textbook, Stroke: Pathophysiology, Diagnosis, and Management, edited by H.J.M. Barnett, J.P. Mohr, B.M. Stein, and F.M. Yatsu (Second edition. New York: Churchill Livingstone, 1992). Cerebrovascular Disease has the advantage of being five years more recent; it provides more extensive coverage of surgical topics but less extensive coverage of such medical topics as migraine, arteritis, coagulopathies, and substance abuse. Appropriately, given its clinical orientation, the book edited by Batjer et al. provides relatively limited information about the basic cellular and molecular mechanisms mediating ischemic or hemorrhagic brain damage and the frontier of neuroprotective approaches, although the chapters included that do target basic mechanisms (such as chapter 12 and chapters 23 through 26) provide excellent and pithy summaries of complex topics. Like the Barnett book, this is a reference book for the specialist — the neurosurgeon, neurologist, or internist who sees a lot of patients with cerebrovascular diseases — as well as for researchers in cerebrovascular disease who want to maintain a cutting-edge clinical perspective. This book will not replace other clinically oriented books that are more compact and thus better suited for service as study guides for the specialist (or as reference books for the nonspecialist), such as Stroke, a Clinical Approach, by L.R. Caplan (Second edition. Boston: Butterworth–Heinemann, 1993) or Cerebrovascular Disorders, by J.F. Toole (Fourth edition. New York: Raven Press, 1990) or others that provide more comprehensive coverage of the pathophysiology of hypoxic–ischemic brain injury, such as the Primer on Cerebrovascular Diseases, edited by K.M.A. Welch, L.R. Caplan, D.J. Reis, B.K. Siesjö, and B.R. Weir (San Diego, Calif.: Academic Press, 1997). But it is a most worthy and important contribution to the literature on stroke; the authors are to be congratulated.

Dennis W. Choi, M.D., Ph.D.
Washington University Medical School, St. Louis, MO 63110