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Acute Stroke Care


Ken Uchino, Jennifer Pary, James Grotta: Acute Stroke Care. 2nd edition. Cambridge University Press, 2011, 234 pp., ISBN-13: 978-0521184847

The second edition of Acute Stroke Care by Uchino, Pary, and Grotta is a pocket-sized practical guide intended for medical students, residents, and other clinicians involved in direct care of the acute stroke patient from emergency department through hospital discharge. The bulk of the text deals with acute ischemic stroke with short chapters addressing intracerebral hemorrhage, subarachnoid hemorrhage, organization of stroke care, and rehabilitation. The text is referenced with a full index, recommended reading, and an extensive set of appendices covering tissue plasminogen activator dosing, sample order sets, a stroke neuroimaging and transcranial Doppler primer, protocols for prevention and treatment of medical complications, stroke neuroanatomy, brain death criteria, and stroke scales.

The volume is organized into chapters addressing each step in the clinical management of acute stroke patients. Material is presented using features that facilitate rapidly finding key information. Chapters are color coded on the edge of the book. Each chapter is well organized with easily identified sections, and there is frequent use of bullet points and easy-to-read tables.

The content of the handbook focuses heavily on acute ischemic stroke. The sections on intracerebral hemorrhage and particularly subarachnoid hemorrhage are somewhat thin. For intracerebral hemorrhage, issues such as management of coagulopathy in patients treated with the new oral anticoagulants, seizures as a cause of neurological deterioration, or which patients should be considered for intracranial pressure monitoring or ventricular drainage are notably absent. Similarly, the sub-arachnoid hemorrhage chapter is superficial, lacking the thoughtful discussion included in the ischemic stroke chapters.

The authors note when recommendations are supported by evidence, and, in situations lacking adequate support, offer their own recommendations. Most of the time, this approach is transparent and effective. Occasionally, recommendations (for example, aggressive glucose management) actually go against guidelines or serve to perpetuate non-evidence-based practice, particularly with regard to antithrombotic management of stroke with presumed cardiac or aortic embolic etiology.

Although published in 2011, some of the recommendations already need updating given results from recent pivotal trials regarding carotid (CREST) or intracranial (SAMMPRIS) stenting, factor Xa inhibitors in atrial fibrillation (ROCKET AF, ARISTOTLE), bridging intravenous to intra-arterial thrombolysis (IMS3), and mechanical thrombectomy with the Solitaire stent retriever (SWIFT). But, given the target audience, this does not greatly diminish the value of the handbook. It is an excellent resource, providing a well-organized, concise and easy to use guide to carrying out the 'nuts and bolts' of care for acute ischemic stroke patients.

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Correspondence to Allyson R Zazulia.

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The authors declare that they have no competing interests.

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Both authors contributed to writing and revising the manuscript.

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Zazulia, A.R., Diringer, M.N. Acute Stroke Care. Crit Care 17, 301 (2013).

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