Rabinstein AA, Resnick SJ. Practical Neuroimaging in Stroke: A Case-Based Approach. SAUNDERS Elsevier 2009, 416 pages, $186.00.
This 416-page hardcover book is a compilation of case material, basically called “case vignette” and comes with the capability of searching the full text online. Each case serves as a backdrop for discussing the particular entity in question. It is supplemented by further illustrations of other case material. The categories (each a different chapter) are: Hypoxic-Ischemic Brain Damage; Clinical-Anatomical Syndrome of Ischemic Infarction, Acute Stroke Imaging, Cardiac Embolism, Extracranial Large Artery Atherothrombosis, Intracranial Atherosclerotic Disease, Small Vessel Disease, Uncommon Causes of Stroke, Spinal Cord Infarction, Spontaneous Intraparenchymal Hemorrhage, Secondary Intraparenchymal Hemorrhages, Subarchmoid Hemorrhage, Vascular Anomalies of the Brain, Cerebral Venous Thrombosis.
All of these chapters should be of interest to the neurologist and neuroradiologist particularly so related to the one on Acute Stroke Imaging. Here the radiologist would be most interested in the protocols used for CT perfusion and the imaging, whether it is CT and/or MR based. Further, in this chapter there are 3 basic subsections: Computed Tomography; Magnetic Resonance Imaging; Imaging in Stroke Emergencies. Each has a number of case history vignettes which bring to reality the imaging which follows. The material reviews concepts are well known to neuroradiologist (e.g. insular ribbon sign, dense MCA, sulcal effacement, contraindications for thrombolysis, Alberta Stroke Program early CT Scores vs. ELASS, evolution of stroke to subacute and chronic stages). The section on MR Angiography (½ page) is skimpy and gives few if any technical details, and many of the explanations could have been more detailed and forthcoming.
Built into a number of sections of this book are discussions of treatments — although not extensive, this adds value to this imaging text. One extra item that could have been added would have been a brief description of treatment in the legends for various cases shown. No treatment for example was mentioned in the legend when there was a large penumbra in relation to virtually no alteration in the CBV on CT perfusion. Concerning MR little is said about the actual parameters used in DWI for example. Certainly a mention of various B values (and demonstration of such) in the setting of stroke would have been of value. All that said, this reviewer does recognize that the authors did not intend to write a text on stroke but rather primarily show case material. The chapter is on acute stroke accurate and valuable and to those with limited experience in stroke imaging.
The authors have chosen their images well, with most cases demonstrating high quality MRs and CTs. Additionally, solid explanations are offered for the findings seen on MR or CT such as the reason for the non-hemorrhagic hypertensities seen on T1WIs in cerebral hypoxia, timing of their appearance, the reason for areas of vulnerable cortex, the false subarachnoid hemorrhage sign, and the theorical reason for the delayed appearance of white matter abnormalities in anoxic/ hypoxia injuries.
The legends throughout are in the main complete, but one has to wonder, for example, why in a large MCA infarct where the authors show both the CT and MR, they fail to mention a hyper dense clot in the right MCA. It should be noted that throughout the text the authors deal with important issues and terminology in a straightforward and unambiguous manner such as when they are describing territorial infarcts and their vascular supplies. In the future, the authors should consider labeling arteries in the PA view of the MCA and ACA; they did include such labeling of the vertebral–basilar system but not of the MCA and ACA. Territorial involvement of infarcts involving various branches of the intracranial circulation are well and simply described, and much of this would have appeal to the neuroradiologist because of the identification of various symptoms and syndromes. Some but minimal editorial/publisher errors are noted, such as the vertical 180º rotation of a vertebral angiogram and the corresponding CT, or poorly windowed CTs and MRs
A review of mechanisms involved in cardiac embolism (chapter 4) nicely puts together neuroimaging and cardiac pathology/physiology. This gives one the chance to briefly review issues with which we as radiologists seldom deal — like the EKG findings in atrial fibullation or the echocardiogram findings in ventricular thrombi. Again, the pleasant part of reading this is the combination of case vignettes and bullet learning points related to both the heart and brain.
Other chapters flow nicely and smoothly as one goes from extracranial vascular disease (nice combination of vascular US and extracranial vascular angiography — DSA/MRA) to intracranial vascular disease to small intracebral vessel disease. The rest of the material is mentioned in the first paragraph of this review.
This is a book well worth purchasing. It puts together in a readable and practical manner the issues faced in dealing with the imaging of stroke.
