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Cerebrovascular diseases Eleventh princeton conference. edited by Thomas R. Price and Erland Nelson Raven Press New York 1979 406 pp illustrated $529

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Cerebrovascular Diseases:
Eleventh Princeton Conference
Edited b.y Thomas R. Price and Erland Nelson
Raven PreJs, New York, 1979
406 pp, illuJtrated, 529.50
The field of cerebral metabolism has taken on multiparous
attributes, giving birth at close intervals to a succession of
symposium volumes, many hastily edited, almost all too
abbreviated in their individual contributions to permit
critical analysis, and most (one suspects) of little enduring
import. Against this generally dismal backdrop the present
volume emerges as a wholesome, if not unmarred, exception. This volume consists of the transactions of the
Eleventh Princeton Conference, held for three days in
March, 1978, and participated in by about one hundred of
the major contributors to the field. These conferences, now
biennial events, date from 1954 and are always eagerly
awaited as timely forums for summarization of current
clinical and basic research trends and, perhaps more importantly, for their lively and free-ranging discussions of
areas of controversy.
The present volume continues in this tradition. It is a
pleasing work, well printed and neatly illustrated. The six
topic areas into which it is divided, each with its own section editor, represent major focuses of current interest: experimental stroke models (Molinari); in vivo mapping of
biochemistry and hemodynamics (Raichle); edema in brain
infarction (Garcia); platelet-suppressive drugs in transient
ischemia (Kurtzke); cerebral vasospasm (Zervas); and autonomic nervous system in stroke (Price). Each section
concludes with a concise summary.
With a few exceptions, this is not a primary source work:
the bulk of the material contained in its formal presentations is readily accessible in published journals. The
unique value of the work is the comprehensiveness with
which it surveys the panoply of current clinical and investigative activity. Thus, the section o n experimental stroke
models, though wanting in new insights, is useful for its organization of animal models and for its lengthy bibliographies. The section on in vivo mapping is particularly
noteworthy for Eichling’s brief y e t trenchant criticism of
noninvasive methods for charting regional blood flow and
for Oldendorfs timely analysis of the economics of head
scanning. T h e experimental offerings on ischemic brain
edema are, in fact, variations o n a by now familiar theme,
though Bruce and Hurtig contribute clinical C T evidence
that progressive cerebral edema does not appear to cause
secondary neurological dysfunction in acute infarction.
Katzman offers a critical and well-referenced restatement
of the therapy for ischemic brain edema. The section o n
treatment of transient ischemic attacks is particularly apposite. Barnett’s masterful Canadian cooperative study of
platelet antiaggregants forms its keystone, though this material is by now fully published in journal form. Abraham
Lilienfeld’s and John Kurtzke’s penetrating critiques are
appended. In the section o n vasospasm, Somlyo’s beautiful
review of vascular smooth muscle contraction and Simeone
and Vinall’s discussion of therapy are particularly useful.
The quality of the formal presentations, however, is not
entirely uniform; some appear rather superficial and stale.
A considerable portion of this volume is devoted to a
nearly verbatim transcript of the generous quantities of
open discussion among conference participants. While
participants themselves may find this a useful means of reliving the moment, it must be questioned whether such an
approach is serviceable for the reader who wishes to be-
come informed expeditiously. The discussion sections are
highly uneven, peppered with the agrammatisms of casual
conversation, many misspellings, and gratuitous references
to colleagues on a first-name basis. Some apparently unedited comments verge on the incomprehensible. Discussants commonly cite their recollections of the published
literature in a disturbingly casual and tentative manner,
without providing the needed reference citations. Themes
are commented upon, dropped, then reencountered a page
or two later. Often, long portions of unrelated discussion
intervene between a question posed and the answer
provided. I cannot help thinking that skillful editing of the
discussions should allow the lively style and important substance of the comments to be retained, while dispensing
with their distracting and disorganized features.
Despite its flaws, this is an important volume, to be taken
seriously by all clinicians interested in cerebrovascular
disease and by investigators in cerebral metabolism and
cerebrovascular physiology. Taken as a whole, it is an authoritative presentation of the state-of-the-art, a compendium of informed opinion, and, through its bibliographies,
a rich guide to primary source material.
Myron D. Ginsberg, M D
Department of Neurology 104-51
University of M i a m i
School of Medicine
PO Box 01 6960
Miami, FL 3.3101
Children’s Learning a n d Attention Problems
B y Marcel Kinsbourne and Paulu J . Caplan
Boston, Little, Brown and Company, 1979
300 pp, illustrated, $1 7.95
A pediatric neurologist (Kinsbourne) and a psychologist
(Caplan) have teamed up to produce a textbook on learning
and attention problems in children. The target audience is
meant to include physicians, psychologists, and parents and
teachers of the learning disabled. Introductory information
and a detailed exposition of what the authors call cognitive
power disorders (learning disabilities) and cognitive style
disorders (hyperactivity and the “overfocused” child) are
provided. The bulk of the text discusses the cognitive
power disorders in terms of description, diagnosis and
diagnostic techniques, prognosis, and remediation; an
analogous approach is used for cognitive style disorders.
In general the presentation is logical and easy to follow,
although it is very much like reading one of Dr
Kinsbourne’s lectures. This makes the volume useful for a
reader with little knowledge of the topic, but the material is
overly simple for anyone with a background in the field.
A number of areas are discussed with more certainty
than the evidence justifies and represent the authors’
biases. The new terminology of cognitive power and cognitive style disorders adds little, and there is no clear statement of the interactions of the two. In addition, the category of the overfocused child, although potentially useful,
is developed in global fashion that gives little guidance for
diagnosis.
Cognitive power disorders are viewed from the perspective of a developmental lag, a model with limited usefulness
for many affected children. The role of neuropsychological
testing is minimized, but “educational” testing is recommended to determine specific areas of deficit. O n the one
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erlang, 1979, illustrated, princeton, disease, eleventh, price, new, cerebrovascular, york, conference, 406, thomas, edited, rave, nelson, pres, 529
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