Cerebrovascular Ultrasound in Stroke Prevention and Treatment - Tapa dura

Review of the textbook "Cerebrovascular Ultrasound in Stroke prevention and Treatment" Edited by Andrei V. Alexandrov Assistant Professor of Neurology and Radiology, Director, STAT Neurosonology Service and Center for Non-invasive Brain Perfusion Studies Stroke Program, University of Texas-Houston Medical School Houston Texas First Edition, 2004. 267 pages. Blackwell Publishing www.blackwellpublishing.com, www.blackwellfutura.com This book has been produced by an international team of contributors, edited at the University of Texas and is aimed at three types of individuals: beginners to learn the basics of ultrasound testing, advanced users to learn differential diagnosis and clinicians involved in treating stroke patients. The text is packed full of useful practical information and has excellent illustrations and TCD images. However, the content is not basic and beginners wishing to start TCD would be advised to read simpler texts prior to this book. It is divided into five parts: Part I-How to perform ultrasound tests covers both extracranial and intracranial ultrasound examination with an emphasis on standardisation for carotid duplex. The techniques for carrying out single-gated spectra (TCD), power-motion Doppler (M-mode) and transcranial colour duplex imaging (TCCS) are outlined in a simple and clear manner. The advantages of M-mode (easier window-finding) and TCCS (identifying anomalies of the circle of Willis) for the beginner are emphasised but the caveat for both M-mode and TCCS is spectral resolution and it is acknowledged that experienced operators will still use single-gated TCD. Part II-Haemodynamic principles is a "heavy" section but will be of particular interest to anyone working in the intensive care/surgical setting. The chapter on practical models of cerebral haemodynamics importantly emphasises spectral waveform recognition rather than the usual emphasis on velocity. Part III-Criteria for interpretation. is an excellent section covering diagnostic and validation criteria for carotid stenosis, carotid and vertebral artery dissection and occlusion, intracerebral arterial vasospasm, embolism detection, with a good description of the TIBI ultrasound classification for large vessel occlusion. Part IV-Ultrasound in stroke prevention and treatment covers ultrasound findings of specific diseases including sickle cell disease, cardiovascular risk, secondary stroke prevention, acute ischaemic stroke, subarachnoid haemorrhage. The chapter on ischaemic stroke discusses the potential therapeutic use of TCD and is well worth reading. Part V-Select clinical applications and clinical vignettes includes an interesting collection of anecdotal vascular cases covering areas, which can give diagnostic difficulty. The exciting parts of this book have to be the emphasis on the potential therapeutic use of diagnostic TCD and the focus on waveform analysis rather than velocity measurements. This opens up TCD as a bedside tool, which will hopefully mean that more clinicians will start using this powerful technique. Dr Paul Syme Consultant Physician Lead Stroke Physician NHS Borders Part-time Senior lecturer University of Edinburgh

Ultrasound enables us to monitor the cardiovascular system and brain responses to treatment in real time; a genuine blessing on the route to more effective stroke therapies, and an invaluable tool with which to tailor treatment when available evidence is meagre. Ultrasound is a vital observational tool, yet a probe needs a scientist to point it in the right direction and a skilled physician to synthesise scientific data with practical management strategies. This book, intended for clinicians who are eager to learn and prepared to observe, focusses on the examination of stroke patients, the interpretation of ultrasound studies, and the application of cerebrovascular ultrasound to management and treatment strategies.Produced by an international team of contributors and edited at the University of Texas, one of the major world centres in stroke research, it is a practical volume that can be used by beginners to learn the principles of ultrasound testing, by advanced users to learn differential diagnosis, and by clinicians (non-sonographers) who treat stroke patients. The latter will gain knowledge on how to apply ultrasound, and what to expect from it in terms of clinical decision making and treatment selection.