Uncommon Causes of Stroke

doi:10.3174/ajnr.A1445

L.R. Caplan and J. Bogousslavsky, eds. Cambridge; 2008, 576 pages, 9 line figures, 217 halftones, 8 plates, 83 tables, $195.00.

The apparent aim of Uncommon Causes of Stroke (576 pages, 110 authors), edited by Drs Caplan and Bogousslavsky, is to catalogue and describe many of the unusual causes of stroke. From an imaging point of view, the text is disappointing and, for that reason, will be of limited interest to neuroradiologists and neurointerventionalists. While one could use this book to read about 70 unusual causes of stroke, from a practical standpoint, it is not particularly helpful for someone trying to figure out the underlying cause of an apparent stroke/cerebral ischemia.

Although it might have been somewhat cumbersome to accomplish, a more educational (and virtually self-testing) approach would have been to present the reader with the salient history and images and allow the formation of a differential diagnosis. Then the discussions in each case could have centered around what, in both the history and imaging, would lead one to the proper diagnosis. This book leaves us, at times, with some antiquated imaging and only a moderate sense of what modern techniques can contribute.

Take mitochondrial myopathy, encephalopathy, lactacidosis, and stroke as just 1 example. Here we are shown only an axial CT scan with bilateral basal ganglion and thalamic calcifications. There is no MR imaging, no diffusion-weighted MR imaging/apparent diffusion coefficient, and no MR spectroscopy shown. In the aneurysm chapter, there are no MR angiograms (or routine MR images at all), which one would have to consider a major deficiency. In Susac syndrome, a single extremely poor-quality MR image is shown with a legend, which is not helpful and, in fact, is underdescribed. Faults like this can be found in every chapter. How one can write/edit a book in 2008 on stroke and have only a couple of diffusion-weighted images is mystifying.

In fact, the quality of the neuroimaging throughout is embarrassingly poor. With all these authors, one could have hoped for more robust and up-to-date imaging contributions. Perhaps to a subset of neurologists, the book may be of value, but to the neuroradiology community, it is not recommended.