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Journal of Neuroscience Nursing:
doi: 10.1097/.0b013e318234ea5a
Media Review

Intracranial Atherosclerosis

Jacobson, Kristine MSN RN CCNS CNRN CBIS; Woods, Jennifer Section Editor

Free Access

J. S. Kim, L. R. Caplan, & K. S. Lawrence Wong, Editors, West Sussex, United Kingdomml: Wiley-Blackwell, 2008, 272 pages, $154.95, ISBN: 978-1405178228.

Intracranial Atherosclerosis is an intensive study into a pathological occurrence often disregarded. It takes the reader through an in-depth review of research and physiology detailing intracranial vasculature. This is a concise, academic-type text for those with special interest in cerebrovascular disease and stroke. The book is divided into five sections: epidemiology and risk factors, stroke mechanisms and clinical consequence, diagnostic imaging studies, treatment, and uncommon causes of intracranial arterial disease. Each chapter within a section provides research and clinical information specific to its topic.

The first division of the text provides epidemiological context and risk factors for the development of cerebrovascular disease. A review of the anatomy of the intracranial vasculature is thorough, ranging from embryological development and arterial wall composition through characteristics of each individual artery. Later chapters go on to describe the pathology of atherosclerosis, the worldwide epidemiology of intravascular pathology, and the risk factors for its development. Interesting material brought to light is the ethnic and racial differences of vascular pathology. The material covered in these chapters is statistically dense but flows logically and is of good fundamentals for the remaining content.

The following section of text details the mechanisms of stroke and the clinical consequences of intracranial pathology. Stroke mechanisms outline the embolic, thrombotic, and hypoperfusion etiologies of stroke, along with the symptoms of each vascular territory. Specific attention in latter chapters is paid to both anterior and posterior circulation disorders with their respective clinical manifestations and syndromes. These chapters are particularly beneficial to bedside practitioners. Some of the lesser known manifestations of intracranial vascular disease are covered in-depth, including cognitive dysfunction, dementia, and emotional disturbances. This particular chapter provides interesting insight into some rather common problems dealt with on a daily basis in clinical practice. The ending of this section of text is a chapter discussing the natural progression and prognosis of atherosclerosis, which provides applicability to the individual patient and the population as a whole.

The diagnostic imaging portion of the text describes vascular imaging, magnetic resonance imaging and its applications, and transcranial doppler ultrasound studies. Specific studies include catheter angiography, computed tomography angiography, and magnetic resonance angiography. The importance of visualizing the clot, plaque, or stroke to determine the pathogenesis is covered. The need to determine tissue perfusion status via imaging is discussed. In the final chapter, the physics and principles of transcranial doppler ultrasound are outlined, including the detection of large artery stenosis and microemboli. These chapters are very informational for the bedside nurse to understand the work-up of vascular disease. They are also of benefit to advanced practitioners as a guide for ordering testing, which will ultimately dictate appropriate and thorough risk reduction and appropriate acute interventions.

Section 4 of the text, entitled “Treatment,” begins with color pictures of vascular imaging. The images are, for the most part, labeled with arrows pointing out various pathologies; however, there are no explanations accompanying the images. This would have been beneficial for the novice practitioner. Mainstay therapy options are detailed, including antiplatelet therapy, anticoagulation, angioplasty and stenting, and surgical options. The pertinent research and appropriate indications, along with mechanism of action for each treatment, are delineated. The risks and benefits are included, particularly in the surgical intervention chapter. To conclude the section, various other risk reduction and treatment options are discussed, including statins, homocysteine levels, inflammatory and endothelial roles, and cerebral blood flow modulation. This section of the text helps to clarify appropriate intervention for patients with cerebrovascular disease for both the specialist and the nonspecialist practitioner.

The final section covers the zebras of vascular disease, the possible etiologies of a clinically uncommon stroke. Topics include systemic lupus erythematosus, angiitis, drug abuse, and vasoconstrictive syndromes. Also included is a discussion of structural deficits leading to stroke, including arterial dissection, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, sarcoidosis, radiation injury, and infectious sources. The conclusion of this section provides in-depth coverage of moyamoya disease, a relatively common occurrence in Asian populations with diagnosis rates on the rise in this time of advanced imaging. The discussion of these disease processes should provoke a more deliberate and thorough examination of each stroke patient, along with insight into appropriate treatment options and risk reductions.

Intracranial Atherosclerosis is an exceedingly thorough text, provided in a concise format. The research and statistical content provides validity to the text but proves daunting to read. It is strong in fundamental knowledge of intracranial vasculature and pathology. There is bedside applicability within the chapters, particularly the section outlining stroke mechanisms; however, for the most part, it is an academic text for those with intense interest in intracranial vascular disease. It would be a robust addition to the library of those in the vascular neurology specialty, as it comes from some of the leading minds of the stroke world today.

Reviewed by Kristine Jacobson, MSN RN CCNS CNRN CBIS, Clinical Nurse Specialist, Neurocritical and Neurovascular Care Neurology & Neuroscience Associates, Inc., Akron, OH.

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