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Stroke. Pathophysiology diagnosis and mangement ed 2. Edited by Henry J. M. Bamett Bennett M. Stein J. P. Mohr and Frank M. Yatsu New York Churchill Livingstone 1992 1 270 pp illustrated $225

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BOOKS
Reviews
Stroke. Pathophysiology, Diagnosis, and Management,
ed 2
Edited by Henry J . M . Barnett, Bennett M. Stein, J . P. Mohr,
and Frank M . Yatsu
New York, Churchill Livingstone, I992
1,270 pp, illustrated, $225.00
The first edition of this book, published in 1086, provided
encyclopedic coverage of clinical aspects of stroke. As noted
in one review, its highlight was a series of meticulously detailed and thoroughly referenced chapters describing the syndromes associated with occlusion of specific arteries. The
2nd edition, which was extensively reorganized and updated
(60-80% of references in many chapters are new), contains
5 1chapters, in 5 sections on pathophysiology, diagnosis, clinical manifestations, associated diseases, and therapy.
Every reader will find something to like and dislike in a
book of this size. A map of vascular territories superimposed
on horizontal sections of the brain, a useful feature of the
first edition, is now in color and located conveniently near
the front of the book. The chapter on neurochemistry covers
a multitude of timely subjects, including stress proteins and
immediate early genes, but seems disjointed. Magnetic resonance imaging has graduated from the pathophysiology section (where positron emission tomography still lingers) to
that on diagnosis, and the quality of the illustrations has been
greatly improved. The chapter on cerebral angiography is
also well illustrated and covers magnetic resonance angiography; a table correlates abnormal angiographic findings with
the associated diseases, with references to pertinent figures.
Though various noninvasive diagnostic techniques are compared, there is no assessment of when to use them in clinical
practice.
The chapters on clinical manifestations of stroke remain
outstanding. The tenuous basis for classification of strokes as
thrombotic or embolic is reemphasized. Symptoms and signs
associated with strokes in different vascular territories, including in single cases, are described in the painstaking detail
that delights obsessive neurologists. The chapter on lacunes
discusses the nosological dilemma posed by lesions in the
central semiovale and the pathophysiological importance of
microatheromas, lipohyalinosis, and fibrinoid necrosis.
The section on medical diseases and stroke covers antiphospholipid antibodies but mentions MELAS only in relation to migraine. Binswanger’s disease as a neuroradiological
diagnosis is debunked and its relation to leukoaraiosis is clarified. The chapter on stroke in young adults is a useful addition but does not reflect experience at centers where drug
abuse is prevalent.
Stroke therapy is covered in detail. Issues surrounding the
use of aspirin, including the “sex differential” in efficacy and
the controversy over optimal dosage, are considered. Ticlopidine is discussed, as is the evolving role of thrombolytic
agents. Newer views on fibman-Sacks endocarditis in embolic stroke and on the treatment of nonbacterial thrombotic
endocarditis are presented, and the discussion of carotid endarterectomy has been updated to include findings of the
North American and European trials published in 1991.
Chapters on neurosurgical treatment advocate more aggressive approaches to patients in Hunt and Hess grades IV
through V after aneurysmal rupture, and to hemorrhages in
the basal ganglia, thalamus, and brainstem, than would be
favored by many neurologists. The chapter on rehabilitation
provides little encouragement about our ability to prognosticate in the setting of acute stroke.
This is a comprehensive and scholarly book with a strong
clinical emphasis. It is an essential reference for those involved in the care of patients with stroke and a valuable
teaching resource. The extent to which diagnosis and treatment have progressed in recent years-and to which the
book has been revised to incorporate these advances-amply
justifies its purchase, even by owners of the previous edition.
David A. Greenberg, M D , PhD
Molecular Basis of Neurology
Edited by P. Michael Conneally, PhD
Boston, Bluckwell Scientific, 1992
296 pp, illustrated, $39.95
As this book‘s chapter on phenylketonuria makes clear, disorders of the nervous system were diagnosed and treated by
molecular means before the modern era of molecular biology
began. Nevertheless, recent conceptual and technological advances have brought an increasing number of neurological
disorders into the domain of molecular biology and have
produced new insights into mechanisms of inheritance, reclassification of diseases, novel diagnostic approaches, and
even the promise of gene-based therapy. As a consequence,
understanding the clinical applications of molecular biology
is becoming increasingly imporrant in neurological practice.
Molecular Basis of Neurology contains 13 chapters by wellselected experts. An introductory chapter, “Principles of
Molecular Genetics,” is followed by chapters on hereditary
amyloidosis, Duchenne muscular dystrophy, Huntington’s
disease, HPRT deficiency, myotonic dystrophy, neurofibi-omatosis, phenylketonuria, Gilles de la Tourette’s syndrome,
tuberous sclerosis, Charcot-Marie-Tooth disease, mitochondrial myopathies, and fragile X syndrome. The introductory
chapter is an ambitious attempt to explain the arcane terminology and techniques of the field in 54 pages, but, even
with the help of a convenient glossary, is not easily accessible
to the neophyte. The remaining chapters reflect the uneven
state of present knowledge and are most illuminating where
it has been possible to translate laboratory findings into diagnostic or therapeutic returns. For example, the discussion
of myoblast transplantation and gene therapy as potential
treatments for Duchenne muscular dystrophy hints at the
excitement to come as progress in research continues.
The book will be mas[ useful to those with exposure to
molecular biology, including residents and fellows who want
an update on what’s been done and what the future holds.
David A. Greenberg, M D , PhD
Copyright 0 1993 by the American Neurological Association 241
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livingstone, 270, henry, churchill, illustrated, 1992, 225, bamett, new, frank, stroki, bennett, york, mohr, yatsu, mangement, stein, edited, pathophysiology, diagnosis
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