Book Review

Subarachnoid Hemorrhage: Causes and cures

N Engl J Med 1999; 340:1931-1932June 17, 1999

Article

Subarachnoid Hemorrhage: Causes and cures
(Contemporary Neurology Series.) By Bryce Weir. 301 pp., illustrated. New York, Oxford University Press, 1998. $120. ISBN: 0-19-512875-3

Written by an internationally recognized authority on the management of subarachnoid hemorrhage, this monograph has a well-crafted text complemented by figures and tables of high quality. The book's 12 chapters are divided into three sections. The first section covers the history of the disorder and economic and medicolegal aspects, and the second and third sections cover aneurysmal and nonaneurysmal subarachnoid hemorrhage, respectively.

The second section is the heart of the book. An up-to-date chapter on epidemiology and diseases associated with intracranial saccular aneurysms introduces the topic. Subsequent chapters deal with the anatomical features of aneurysms, the physiology of aneurysmal rupture and vasospasm, and the pathology of saccular and nonsaccular aneurysms. The discussion of vasospasm is excellent, but it probably should have been placed in the chapter on the medical treatment of subarachnoid hemorrhage.

The chapter on the diagnostic aspects of subarachnoid hemorrhage is a highlight of the book. Here the author shares his considerable experience in recognizing the clinical and radiologic features of the disorder — for example, he notes that the finding of acute hydrocephalus on computed tomography in an acutely ill patient points to the presence of subarachnoid hemorrhage. There are excellent tables listing the characteristics of the headache associated with subarachnoid hemorrhage, the common alternative diagnoses for the three most common signs of the disorder, and the clinical and radiologic findings on the day of aneurysmal rupture. These tables will be useful to every physician who sees acutely ill patients, because of the high rate of misdiagnosis of subarachnoid hemorrhage.

Weir provides an excellent review of medical measures for the treatment of patients after subarachnoid hemorrhage. A table that lists medications (and doses) used to treat complications of subarachnoid hemorrhage will be helpful to neurologists, neurosurgeons, and intensive care specialists. The chapter on endovascular treatment of ruptured aneurysms is a good introduction to a burgeoning field, but because of the rapid changes in this field, the chapter is likely to be out of date soon.

This book provides an excellent review of the current status of the diagnosis and treatment of subarachnoid hemorrhage. It can be recommended especially to residents and fellows in neurology and neurosurgery.

Harold P. Adams, Jr., M.D.
University of Iowa, Iowa City, IA 52242