Acute Stroke Care

e 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. Th e bulk of the text deals with acute ischemic stroke with short chapters addressing intracerebral hemorrhage, subarachnoid hemorrhage, organization of stroke care, and rehabilitation. Th e 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 neuro anatomy, brain death criteria, and stroke scales. Th e volume is organized into chapters addressing each step in the clinical management of acute stroke patients. Material is presented using features that facilitate rapidly fi nding key information. Chapters are color coded on the edge of the book. Each chapter is well organized with easily identifi ed sections, and there is frequent use of bullet points and easy-to-read tables. Th e content of the handbook focuses heavily on acute ischemic stroke. Th e sections on intracerebral hemor rhage 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 subarachnoid hemorrhage chapter is superfi cial, lacking the thoughtful discussion included in the ischemic stroke chapters. Th e authors note when recommendations are supported by evidence, and, in situations lacking adequate support, off er their own recommendations. Most of the time, this approach is transparent and eff ective. Occasionally, recom mendations (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 recom mendations already need updating given results from recent pivotal trials regarding carotid (CREST) or intracranial (SAMMPRIS) stenting, factor Xa inhibitors in atrial fi brillation (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.