Book Review

Handbook of Cerebrovascular Diseases

N Engl J Med 2006; 354:1541-1542April 6, 2006

Article

Handbook of Cerebrovascular Diseases
(Neurological Disease and Therapy. Vol. 66.) Second edition. Edited by Harold P. Adams, Jr. 862 pp., illustrated. New York, Marcel Dekker, 2005. $219.95. ISBN: 0-8247-5390-9

Stroke is hot right now. Even physicians who do not specialize in vascular neurology — the subspecialty that has just recently gained formal recognition — recognize that after decades of medicine's having very little to offer, therapeutic advances for stroke patients are now coming at a rapid pace. These changes coincide with a new mechanism for designating hospitals as primary stroke centers, developed by the Joint Commission on Accreditation of Healthcare Organizations. The result has been an upsurge in demand for directors of stroke centers, neurohospitalists, interventional neuroradiologists, endovascular neurosurgeons, neurointensivists, and clinical nurse specialists to staff these programs. Central to these stroke centers is the establishment of mechanisms to maintain continuing medical education. There is a lot to keep up with.

Thus, this major textbook focused on cerebrovascular diseases is timely. The second edition of Handbook of Cerebrovascular Diseases is a revised and expanded version of the first edition, published in 1994. It is a standard multiauthored book, but the list of contributors reads like a who's who of cerebrovascular specialists. At 862 pages, it is somewhat less than half the size of the encyclopedic mega-textbook Stroke: Pathophysiology, Diagnosis, and Management, fourth edition (Philadelphia: Churchill Livingstone, 2004), edited by my colleague J.P. Mohr, and as such, it serves as a more succinct and focused reference. Although it may not cover every aspect of cerebrovascular disease in as much detail, it is similarly authoritative.

The 34 chapters of the book are divided into five sections focusing on clinical features and diagnosis, management of cerebrovascular disease (including rehabilitation), ischemic disease, hemorrhagic disease, and special topics. For the most part, the editor has done a good job of creating a coherent book with a consistent voice that emphasizes evidence-based practice. (I could not find a single example of “at our center” or “in our experience.”) Particularly useful are the chapters devoted to the vascular anatomy of the brain, the organization of the stroke team, transient ischemic attacks, antithrombotic and thrombolytic therapy, intracranial stenting, and the surgical management of intracranial aneurysms and arteriovenous malformations. The section on special topics includes clinically relevant chapters on topics such as central nervous system vasculitis; spinal cord infarction; hypercoagulable states; and stroke due to pregnancy, migraine, or cardiac procedures.

One glaring omission is a chapter dedicated to the critical care of stroke (disclosure: I am a neurointensivist). The day-to-day acute management of the sickest stroke patients usually takes place in an intensive care unit (ICU) or step-down unit. Fundamental issues related to ICU management are covered to some extent in a chapter devoted to complications resulting from acute ischemic stroke, but the discussions are sometimes incomplete. For instance, the section on respiratory failure and mechanical ventilation is only half the size of the section devoted to urinary and fecal incontinence.

A few comments seem to be way off the mark, such as the statement that transluminal angioplasty for symptomatic vasospasm after subarachnoid hemorrhage “should presently be regarded as a strictly experimental procedure.” It is fine to argue with the quality of the evidence, but it would seem useful at least to acknowledge that this procedure is currently used as a standard treatment throughout the world. For the most part, though, the book is up to date, thoroughly referenced, and well balanced regarding the most common and contentious topics in stroke management, such as carotid stenting, anticoagulation, intraarterial thrombolysis, and hemicraniectomy — the issues that most often lead us to consult an authoritative book in the first place.

Handbook of Cerebrovascular Diseases would make a nice addition to the library of any neurologist, neurosurgeon, radiologist, intensivist, emergency medicine physician, nurse practitioner, or other health care provider who deals regularly with patients with stroke or who participates as a member of a stroke center. In this age when everyone has access to PubMed, the main advantage that comes with textbooks such as this is hearing directly from the experts about how they approach a certain problem, and why.

Stephan A. Mayer, M.D.
Columbia University, New York, NY 10032
sam14@columbia.edu