Toyoda K, Anderson CS, Mayer SA, volume eds. Bogousslavsky J, series ed. New Insights in Intracerebral Hemorrhage. Frontiers in Neurology and Neuroscience, Vol. 37. Karger; 2016; 198 pp; 31 figures; $155
Despite recent advances in the treatment of ischemic stroke, cerebrovascular disorders remain the 3rd highest global cause of mortality and a main cause of adult disability. Intracerebral hemorrhage accounts for about 1 in 5 strokes, affects about 2 million individuals annually, with little change in worldwide incidence in the past 2 decades, and has a high 30-day fatality. It disproportionately impacts minorities in the US and low- and medium-income countries, and at a younger age than other stroke subtypes. Only a minority of survivors is able to return to gainful employment or premorbid activities; therefore, with a worldwide prevalence of about 5 million, the societal impact of this condition is significant. Even as thrombolysis and mechanical endovascular recanalization for acute ischemic stroke has become the standard of care, treatment options for acute intracerebral hemorrhage remain frustratingly elusive.
It is against this background that the book New Insights in Intracerebral Hemorrhage is a welcome review of the state of affairs in this condition. A small and eminently readable work, it is an international collaboration of 3 editors from 3 continents. Experts in clinical and critical care, surgery, and imaging, have authored the 14 chapters. The book addresses topics of current interest, such as microhemorrhages, treatment of novel anticoagulant-related hemorrhages, and minimally invasive surgical options for intracerebral and intraventricular hemorrhages.
While this volume addresses the areas of interest in intracerebral hemorrhage, the reader should approach this work as an overview rather than a comprehensive, in-depth review. Nonetheless, some topics are particularly insightful. This reviewer enjoyed the chapters on epidemiology in which some novel risk factors are discussed, including the role of apolipoprotein E genetic variants on lobar bleeds and the association between the use of selective serotonin reuptake inhibitors and risk of hemorrhagic stroke; a chapter on ultra-early hemostatic therapy and the use of coagulation factor replacement and specific antidotes for anticoagulation-related hemorrhages; and a chapter that details risk factors and predictive scores for reperfusion-related events. The segment dedicated to microbleeds critically appraises pathologic correlates, diagnostic criteria, risk factors, and the relevance of these imaging findings in predicting risk of hemorrhage in diverse conditions. Four chapters address the controversial subject of surgical interventions, with an excellent review of the history and current state of intraventricular thrombolytic treatment. A chapter on brain arteriovenous malformations is a good review for those that do not encounter this condition on a regular basis.
Of particular interest for the radiology audience are the careful review of risk of early hematoma expansion by the “spot sign”, the baseline imaging clues to increased risk of reperfusion hemorrhage, and the chapter on microhemorrhages. Also, the chapter on vascular imaging points to the presence vascular abnormalities in spontaneous intracranial hemorrhages and proposes an algorithm that may be somewhat different than that utilized in most practices in the US, and therefore of potential interest.
Like in most printed books, the delay in final publication is evident in a scarcity of very recent citations; this is not of major consequence in most areas, and the overall message remains undiminished. Overall, this is a succinct and timely review of intracerebral hemorrhage and a worthwhile read.
