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THE LANCET Neurology Vol 1 July 2002 http://neurology.thelancet.com198

Media watch

Cerebrovascular Disease:Momentum at the End of theSecond MilleniumEdited by Dennis W Choi, Ralph G Dacey,Chung Y Hsu, William J PowersFutura Publishing, 2001 $125, 480 ppISBN 0879934840

This American Heart Association monograph is based onproceedings of the 21st Princeton Conference onCerebrovascular Disease held in St Louis in 1998. Theorganisers identified eight themes to mark the progress ofstroke research into the millenium. These includedextracranial–intracranial bypass, pharmacological mediatorsand modulators of ischaemic injury, white-matter injury,inflammation, brain imaging, apoptosis, delayed neuronaldeath and cortical reorganisation, and treatment after acutestroke. While I accept that the editors had to be selective intheir choice of subjects, it seems odd that there was not onemention of the current role of either carotid surgery orangioplasty and only a very limited review on the trials ofthrombolysis.

Despite its unambiguous title, it remains difficult toenvisage just who the target readership was meant to be. Verylittle content is actually clinical. The section on white-matter

injury is excellent, and I did enjoy the section on the renewedextracranial–intracranial bypass debate and the overview ofneuroprotective agents, but each one of these is too brief. Thevast majority of this book is devoted to advances in“subcellular” physiology and pathology and is almostexclusively based on animal studies. After several hundredpages of complex experimentation, the clinical reader willalmost certainly retain the viewpoint that not an awful lot ofthis type of work has successfully made the transition fromyoung rats or gerbils to elderly atherosclerotic human beings.

Who, therefore, will benefit from reading this book? I havefor one and I will certainly refer to some sections in the future.However, the heavy bias towards laboratory-based researchwill not endear this book to clinicians seeking a true overviewof the current state of stroke care and research in 2000 (assuggested by the title). It will, however, prove invaluable to anyscientist or clinician embarking on a period of laboratory-based research into cerebrovascular disease.Ross Naylor

Cerebrovascular Ultrasound:Theory, Practice and FutureDevelopmentsEdited by Michael G Hennerici andStephen P MeairsCambridge University Press, 2001£140, 442 ppISBN 0521632234

This publication documents the amazing developments in ultrasonography during the last 5 years. The basic physical principles of B-mode and dopplerultrasonography, and their established and more recentlydeveloped uses are informatively presented in 29 richlycolour-illustrated chapters.

Early assessment of atherosclerosis and later follow-upof mature lesions or plaques have been refined during thepast few years, although imaging is still used mostly forresearch purposes. Ultrasound-imaging measures areincreasingly used in trials as surrogate endpoints forassessment of the efficacy of atherosclerosis prevention,especially the arterial intima–media thickness. One of themajor advances in atherosclerosis detection withultrasound is the replacement of subjective evaluationmethods with computer-assisted, objective evaluationmethods. This change has resulted in more reliable carotidplaque characterisation. Plaque characterisation by high-resolution B-mode ultrasound might aid stroke prediction in patients with carotid stenosis. More sophisticated imaging methods such as multigated emboli detection with transcranial

doppler insonation through temporal or occipital bonewindows are also described.

Cerebrovascular ultrasonography in both three andfour dimensions (including motion as a vector) has beendeveloped and intensively studied by the editors of thisbook. I have seen their astonishing four dimensionalmovies depicting asynchronous movement of potentiallyunstable atherosclerotic plaques. These plaques are capableof rupturing and causing clinical ischemic events.

Finally, the future is addressed in a discussion of theuse of ultrasonic thrombolysis in recanalisation therapy foracute stroke within the first 3–6 h after symptom onset;however, this method has not been tested in clinical trialsyet—only in animal models.

The information covered in this text represents trulyimportant advances in the understanding and clinicalapplication of ultrasound techniques. Ultrasound remainsa safe, non-invasive, mobile, and inexpensive diagnosticmethod, compared with other diagnostic techniques. Nomethod of imaging can stand alone in all patients, but asshown in this text, ultrasound can have key roles inscreening, rapid haemodynamic assessment, char-acterisation of atherosclerotic lesions, monitoring, andfollow-up; it also has some unique capabilities that noother diagnostic tool can provide. Ultrasound shouldcertainly be included as part of the diagnostic repertoirefor the best and most cost-effective care of patients withstroke and cerebrovascular disease. I fully recommend thisinstructive and comprehensive book to all physicianscaring for these patients.Marie-Louise Moes Grønholdt

The Lancet Neurology is developing a panel of expert bookreviewers. For more information please contact Peter Hayward, The Lancet Neurology, 32 Jamestown Road,London, NW1 7BY, UK. Tel; +44 (0)20 7424 4364; email peter.hayward@lancet.com.