Second edition. Henry J. M. Barnett, J. P. Mohr, Bennett M. Stein, and Frank M. Yatsu. 1270 pages. New York: Churchill Livingstone; 1992. $225.00.

Much has happened in the study of stroke since the first edition of this book appeared in 1986. Magnetic resonance imaging continues to show unimagined details. Carotid endarterectomy has been proven highly effective in symptomatic patients with 70% to 99% stenosis, and anticoagulants have been shown to decrease substantially the risk for stroke in patients with atrial fibrillation. In addition, ticlopidine has been added to the repertoire of effective antiplatelet agents and evidence is growing for a therapeutic window in the treatment of acute stroke.

This book discusses all of these advances and the bases for them. The two volumes of the first edition have been compressed into one and the pages trimmed from 1274 to 1201. The result is more user friendly. The 51 chapters are organized into five major sections on pathophysiology, diagnostic studies, clinical manifestations, specific medical diseases, and stroke therapy.

The coverage is thorough and authoritative but somewhat overlapping. Gaps also occur. There is a chapter on stroke in the young but only scattered references to stroke in the elderly, a reference in the index to cerebrospinal fluid in stroke in evolution but no reference to stroke in evolution itself, and allusion to the aortic valve as a source of cerebral emboli but not to the aortic arch as a potential source of trouble.

The book's size and the multiplicity of authors and approaches limit its utility as a bedside guide to the diagnosis, treatment, and prevention of stroke. However, for depth of coverage of individual subjects and as a reference for cerebrovascular diseases, it has become the standard.