Principles of Cerebrovascular Disease

Harold P. Adams, Jr, MD 564 pages. New York, NY: McGraw-Hill; 2006. $159.00. ISBN 0071416536 In the decade since the US Food and Drug Administration approved intravenous thrombolysis, the use of evidence-based therapy in the treatment of stroke patients has become increasingly prevalent. This has occurred because of the growing weight of evidence-based medicine in general and the increased availability of clinical studies in stroke outcomes in particular. As a consequence, guidelines set by the American Heart Association influence modern stroke management more than at any time in the past. Emphasis continues to shift from an understanding of the underlying concepts of cerebrovascular pathology to the delivery of care to the patient. Published studies that show that dedicated stroke units improve patient outcomes have led the American Heart Association to encourage the integration of different disciplines of health care into independent stroke centers. The comprehensive stroke center as a distinct service, physically separate within the hospital, has arisen as the model for modern stroke treatment. As multidisciplinary entities, the efficacy of these centers depends not on whether they are staffed by neurologists or internists, but on whether the attending physicians have a broad knowledge of all facets of stroke management. To oversee such a program requires training in rehabilitation and prevention as well as emergency management and intensive care. The recent Accreditation Council for Graduate Medical Education accreditation of stroke training programs and board certification in …