Book Review

Cerebrovascular Disease: Pathophysiology, diagnosis, and management

N Engl J Med 1998; 339:1402-1403November 5, 1998

Article

Cerebrovascular Disease: Pathophysiology, diagnosis, and management
Edited by Myron D. Ginsberg and Julien Bogousslavsky. 2067 pp. in two volumes, illustrated. Boston, Blackwell Science, 1998. $495. ISBN: 0-86542-425-X

The field of the cerebral vascular diseases was relatively static for many years, but in this “Decade of the Brain,” the pace of discovery has rapidly increased. The editors of this textbook have attempted to provide an authoritative compendium and reference source for the field. The contents combine topics in both basic science and clinical neurology, and it is the only work of which I am aware that has attempted to do so. Subjects covered include animal models; the neurochemistry of stroke, which is discussed in detail; brain plasticity; strategies of neuroprotection; recent developments in neuroimaging technology; epidemiology; stroke syndromes; research-related aspects of clinical topics; methods of clinical investigation; causes of stroke; current care of patients; and experimental therapy. The authors of the chapters include many of the best-known clinical and basic investigators in the field. The book is produced with high-quality materials, and the figures and tables are attractive.

The intent of the editors and publisher is quite ambitious, and the scope of their project creates some important difficulties. I am unable to identify the intended audience. This work consists of a two-volume set that is over 2000 pages in length and costs approximately $500. However, the editors state that they believe it will be useful for medical students, graduate students, postdoctoral fellows in neuroscience, practicing clinicians, and investigators at the bench. In addition, it appears that assembling 145 chapters and publishing the two volumes took almost two years, since the most recent papers cited appeared in 1996. The editors faced a substantial challenge in getting this many authors to complete their manuscripts, and additional time was required for production. As a result, at the time of distribution, the content of the book was already at least two years old. For much of the clinical material, this delay is not much of a deficiency, but for topics in basic science, the information is already somewhat dated. The sections on therapy are even more affected.

Medical students will find the cost of the two volumes to be high and the material very specialized. Graduate students may consider the extensive treatment of clinical material of little interest. Practicing clinicians are likely to regard the extensive discussions of clinical and basic research as irrelevant to their needs, and investigators at the bench may find the information somewhat stale. Perhaps postdoctoral fellows will benefit the most from this set. Some of these topics have been covered by the same authors in previous, smaller books, but assembling all of this material in one location has some value.

The most important problem for clinicians comes in the area of therapy. Basic research is an international endeavor, but clinical practice is much more regional. Most of the clinical chapters were written by European clinicians, whose attitudes toward stroke therapy differ in important ways from those commonly held in the United States. This difference is particularly important in the field of thrombolytic therapy, where a revolution is in progress. Notably, tissue plasminogen activator has been approved for management of acute stroke in the United States but not in most European countries. Also, the timing of this textbook was unfortunate. The most important studies supporting thrombolytic treatment for acute stroke were published in 1995 and are not covered adequately in this book. Important controversies and further refinements in this field have occurred since the authors completed their work.

Perhaps the deficiencies I have noted are unavoidable in a work that attempts to document the status of a rapidly moving field of investigation. This set of books contains a substantial body of work, and in general the chapters are well written. It may be useful for specialized purposes as a reference source, but it is unlikely that anyone will want to read it from cover to cover and cover to cover.

Justin A. Zivin, M.D., Ph.D.
University of California, San Diego, La Jolla, CA 92093-0624