Management of acute stroke

Abstract

Management of acute stroke Ashfaq Shuaib, Larry Goldstein; New York; 1999; Marcel Dekker; 541 pages; $175.00. Management of Acute Stroke, edited by Ashfaz Shuaib and Larry Goldstein, provides a critical review of current stroke evaluation methods and treatment studies. Unlike other recently produced texts on stroke management, it emphasizes broad treatment strategies rather than the management of specific disease processes. The relatively short chapters and frequent use of tables help to make it a very readable textbook. The first half of the book addresses prehospital and hospital evaluation of the patient with acute stroke and includes a chapter each on the common causes of stroke in children, young adults, and elderly adults. Certain chapters in this section, especially the laboratory investigations in acute stroke, provide concise, practical information. Those chapters reviewing the causes of stroke in different age groups are packed with lists and, perhaps because so few chapters are allocated for these subjects, provide a more superficial treatment of each topic. Although included in this section, the chapter examining the pathophysiology of ischemic brain damage provides an excellent preview of the treatment section and fits better in the second half of the book. The strongest chapters of this book are those evaluating the myriad stroke treatment trials encompassing stroke prevention, acute treatment, and rehabilitation, which are found in the second half of the book. The chapters discussing heparin, thrombolytics, and the glutamate antagonists in acute cerebral ischemia provide comprehensive reviews of the pharmacology of these agents and the treatment trials performed to date. All chapters are well referenced. The chapter examining drugs and the recovery of function contains information neglected in other stroke texts. One of the difficulties in writing an up-to-date stroke textbook, at least when it is not on-line, is the current rapidly changing nature of the field. Although generally comprehensive, the chapters referring to surgical treatment of stroke did not incorporate the North American Symptomatic Carotid Endarterectomy Trial data for symptomatic carotid stenoses of 50% to 69%. These data were presented a year prior to many of the acute stroke treatment trial results that were included in the book. Except for a brief section, the current status of neurointerventional techniques for stroke prevention was omitted. Because much of the content of the book emphasizes general treatment approaches, many of them investigational, it is most useful to someone interested in the theory of stroke treatment. In this light, it provides a well-balanced review of the data. This book is less helpful to the clinician interested in the specific management of a clinical syndrome.