Acute Stroke Treatment

Acute Stroke Treatment

Bogovsslavsky J, editor

London (UK): Martin Dunitz; 1997. 304 pp with index

ISBN 1-85317-413-0 (cloth)

Few fields in medicine are undergoing a greater shift from despair to hope than stroke therapy. As the editor points out, the title of the book itself — Acute Stroke Treatment — would have been taken as a bad joke even just a few years ago. So what has changed? First, there is converging evidence of a therapeutic window between the onset of the neurological deficit and intervention. Second, stroke units have been demonstrated to be effective in reducing mortality, morbidity and length of hospital stay. Third, a US National Institutes of Health study has demonstrated that, if tissue plasminogen activator is given within 3 hours of a stroke in selected patients, 12% of them will have minimal or no neurological deficits compared with control patients.

This book addresses all the relevant areas of acute stroke treatment. It begins with a thoughtful overview of acute stroke management from around the world by Stephen M. Davis and colleagues, and continues with practical chapters on clinical, imaging, ultrasonography and cardiac evaluations. Chapters by Kogure and associates, and by Dolkara and Moskowitz, identify the experimental evidence for therapeutic targets for clinical stroke. Separate chapters address intensive care treatment of ischemic stroke, thrombolysis neuroprotection, gene therapy and surgery. Lawrence M. Brass contributes a conceptually valuable chapter on “Ideal Trials for Acute Stroke/’ and the book concludes with chapters on the treatment of intracerebral hemorrhage, subarachnoid hemorrhage, prophylactic neuroprotection for pretreatment of brain infarction and prevention of early recurrent stroke.

All the senior contributors to the chapters are recognized experts in their fields, and the emphasis is on clarity and pragmatism, a compliment to the editor. An obvious objection to a book such as this is that the field is moving so rapidly that many items in this book are already obsolete. However, concepts, approaches and basic knowledge do not change as quickly. Moreover, if there is a major advance, you will be sure to read it, hear it, or see it on the news. Even if you miss it, your patients will tell you about it. As a practical, comprehensive, yet succinct book, it can be highly recommended to all those dealing with acute stroke.