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Doody's Review ServiceReviewer: James M. Mays, MD (St. Luke's Hospital)
Description: The opening two chapters of this book contain a discussion of the epidemiology of stroke and of subtypes of ischemic stroke. Subsequent chapters deal with management of specific risk factors such as hypertension, diabetes, hyperlipidemia, and others, including cryptogenic emboli and other elusive causes of stroke. The editors rightly assume that the best way to treat an individual stroke is to understand the pathophysiology of the event, and they make clear that such a thing is not possible 30 to 40 percent of the time. The bulk of the book consists of practical discussions of what preventive measures are possible and, more importantly, which ones are supported by evidence.
Purpose: The purpose of the book is to provide a practical guide to managing patients at high risk for stroke and in doing so, decrease the high incidence of stroke. These are indeed worthy objectives. The various authors provide practical information about preventive measures and clearly document whether there is evidence in support of such measures or not. In reading over the various chapters one is struck by how much there is that one can do. The authors convinced me that widespread implementation of many of these measures would decrease stroke incidence. Whether any of us is right must await the statistical studies of the next decade.
Audience: The book is intended for those who take care of stroke patients or potential stroke patients. Family practitioners, internists, and neurologists will find the book interesting and useful. As the editors point out in the preface, "Neurologists....are sometimes ill-prepared to assume responsibility for managing such risk factors as hypertension....non-neurologists may feel uncomfortable localizing neurological symptoms and determining pathophysiology for the event." The book will help the comfort level of both.
Features: In addition to well known risk factors, the book has chapters discussing diet and physical activity, hormonal therapy, and serum biomarkers in prediction of stroke risk. There is a good discussion of craniocervical stenting and angioplasty including evidence (or lack thereof) in favor of one procedure or another. Each chapter is complete but not so exhaustive as to make the book unusable.
Assessment: This well written book offers a practical and usable approach to stroke therapy. For the most part the authors avoid being overly dogmatic and understand the limits of our knowledge with regard to stroke care.