MEDIA REVIEWS
THE STROKE BOOK, 2ND EDITION
Edited by. Michel T. Torbey, MD, MPH, and Magdy H.
Selim, MD, PhD.
Cambridge, UK: Cambridge University Press, 2013;
380 pp; $59.95 (softcover).
The Stroke Book, Second Edition, is a concise, well-writ-
ten, easy-to-read book designed for busy professionals
needing quick answers. This revised and updated new
edition includes a chapter summarizing key clinical tri-
als for stroke therapies and a color plate section to illus-
trate key pathology and diagnostic imaging. It covers a
wide range of common conditions such as ischemic and
hemorrhagic strokes, subarachnoid hemorrhages, and
intracranial aneurysms. It also reviews the assessment
and treatment of stroke patients in the emergency
department (ED), intensive care unit, and general hospi-
tal setting. For the emergency physician (EP), this is a
handy resource for navigating stroke-related clinical sit-
uations successfully and making informed decisions
about treatment.
This 380-page book is divided into six sections con-
sisting of 21 chapters. The sections divide the subject
matter into diagnosis, management, and prevention,
with multiple chapters on each topic. This makes it eas-
ier for readers to select which sections and chapters
they would like to review based upon their reading
requirements.
“Section I: Assessment of Stroke Patients” contains
the first three chapters. Chapter 1 discusses emergency
medical services as they pertain to stroke patients. It
discusses the assessment and transport of patients sus-
pected of suffering from a stroke, and prehospital
screening tools, such as the Los Angeles Prehospital
Stroke Screen (LAPSS), the Cincinnati Prehospital
Stroke Scale (CPSS), and several other screening tools
that are used by prehospital personnel. It also briefly
touches on prehospital management and disposition.
Chapter 2 discusses the initial assessment of patients
with strokelike symptoms. In this chapter the signs and
symptoms of strokes and stroke imitators are covered,
along with the physical exams recommended and the
potential physical findings associated with stroke. This
includes a detailed review of the cranial nerves, how to
examine each, and how to conduct a thorough neuro-
logic exam. It also includes the NIH stroke scale
(NIHSS). Chapter 3 discusses clinical stroke syndromes
and localization. It divides the types of stroke syn-
dromes into ischemic and hemorrhagic, distinguishing
between the two based on clinical deficits. It also dis-
cusses determining stroke location based on these syn-
dromes with a thorough review of the blood supply to
the varying cerebral zones and the clinical deficits
seen with a decrease to specific zones. This can be a
useful guide to identifying specific vascular obstruc-
tion or hemorrhage based on the patient’s clinical
presentation.
6 ISSN 1069-6563 6 © 2014 by the Society for Academic Emergency Medicine
E6 PII ISSN 1069-6563583
Section II is titled the hunt for a stroke etiology and is
composed of Chapters 4, 5, and 6. These chapters dis-
cuss the etiology behind ischemic and hemorrhagic
strokes and help identify methods of preventing subse-
quent strokes. Chapter 4 discusses the etiology of ische-
mic strokes. It reviews the history and physical
examinations pertinent to ischemic strokes and then dis-
cusses specific etiologies for the stroke. Chapter 5 dis-
cusses hemorrhagic strokes, the history and physical
examination, and specific etiologies associated with the
occurrence of a hemorrhagic stroke. Both chapters
include the diagnostic studies recommended in the
workup. Chapter 6 discusses those nonneurologic con-
ditions that can mimic a stroke and the uncommon
causes of strokes. The chapter briefly discusses each
condition, but does not discuss evaluation, diagnostic
studies, or management of these conditions.
The third section contains chapters 7, 8, and 9, cover-
ing neuroimaging for stroke patients. These chapters
discuss computed tomography, magnetic resonance
imaging, and neurosonology, respectively. Each chapter
discusses the available neuroimaging and the advanta-
ges and disadvantages of the different types of imaging
and then gives a discussion on the interpretation of
each type of neuroimaging. Throughout each chapter
there are pictures of images from each of the different
types of neuroimaging with adequate explanation.
There are several algorithms discussed that help the
reader with the process of interpreting the different
neuroimaging of a patient suspected of a stroke. This
section may be less helpful to the EP, as it can delve into
detailed descriptions of how to interpret neuroimaging,
which is beyond the usual scope of practice in the ED.
However, the color plates of neuroimaging are very
useful in helping to identify what to look for with a
stroke.
Section IV discusses the management of stroke
patients and includes chapters 10 through 14. Chapter
10 discusses the management of an ischemic stroke in
the first 24 hours, which is valuable to the EP. It reviews
the presentation of stroke patients, history and physical
exam, diagnostics, and pharmacologic therapy, includ-
ing thrombolytic therapy. Chapter 11 discusses the
management of the acute ischemic stroke patient
beyond the first 24 hours. This includes management in
the intensive care unit, seizure prophylaxis, cerebral
edema prevention and treatment, antithrombotic ther-
apy, revascularization, and early rehabilitation. Chapter
12 discusses the assessment and management of intra-
cerebral hemorrhage. It reviews the clinical presenta-
tion, diagnostics, and the medical management. It
provides a thorough discussion of the emergency man-
agement and critical care for hemorrhagic strokes,
including blood pressure management, intracranial
pressure control, anticoagulation reversal, and fluid
resuscitation. This chapter briefly discusses the surgical
management of intracerebral hemorrhage at the end of
doi: 10.1111/acem.12456
ACADEMIC EMERGENCY MEDICINE • September 2014, Vol. 21, No. 9 • www.aemj.org
the chapter. Chapter 13 discusses subarachnoid hemor-
rhage, covering the same topics as previously discussed
in chapter 12. Chapter 14 is included in this section and
discusses dural and cerebral venous thrombosis. While
it discusses etiologies of venous thrombosis, including a
review of the anatomy, signs and symptoms, and diag-
nostic tests recommended, it does not discuss patient
management.
Section V, stroke in consultation, deals with special
situations and includes chapters 15 through 17. Chapter
15 discusses perioperative strokes, chapter 16 covers
stroke on the obstetrics and gynecology floor, and
chapter 17 discusses strokes in the pediatric population.
Each chapter discusses the risk factors associated with
each patient population, the most common etiologies or
associated confounding factors, and the most current
practice recommendations on the pharmacologic treat-
ment and management of stroke in each patient popula-
tion.
The final section, section VI, concludes with chapters
18 through 20 and discusses prevention of both initial
strokes and recurrent ones. Chapter 18 reviews the
available antithrombotic therapies and their role in
patients prior to and after a stroke. Chapter 19 has a
very brief discussion regarding the surgical therapies
available for stroke patients, including embolectomy,
endarterectomy, and stenting. Chapter 20 discusses the
risk factors for stroke, giving the current treatment rec-
ommendations for the management of the major risk
E7
factors, such as hypertension; atrial fibrillation; diabetes;
dyslipidemia; cigarette smoking; alcohol abuse; and diet,
exercise, and obesity. The final chapter briefly highlights
the landmark studies in ischemic strokes. It basically
gives a brief abstract, results, and conclusions of pub-
lished studies and trials involving ischemic stroke.
Examples are the NINDS tPA Stroke Trial, IMS III,
CREST, MATCH, and SPAF II.
In summary, The Stroke Book, Second Edition, would
be a good resource for the busy professional who needs
quick answers. This revised and updated second edition
of The Stroke Book is a concise and practical reference
for anyone involved in managing critically ill cerebro-
vascular patients. The addition of the chapter reviewing
landmark studies allows for a quick review of the cur-
rent evidence-based practice for stroke patients. It is
easily negotiable with its excellent sections on basic
stroke entities and the management of the different eti-
ologies of stroke that may be encountered by the EP.
doi: 10.1111/acem.12456
Kathleen Cowling, DO
(cowling911@yahoo.com)
Warren Singleton, MD
Central Michigan University College of Medicine
Department of Emergency Medicine
Saginaw, MI
Supervising Editor: Peter Sokolove, MD.