Manifestations of stroke

The book is divided into two parts namely “Neurologic and Other Disorders” and “Topographic Syndromes”. The first section begins with the motor syndromes, the most common stroke clinical syndrome. The authors have elaborated the various motor manifestations in a simple way. The stroke sensory syndromes are dealt with in a concise manner. The chapter on eye movement abnormalities is very informative. However, inclusion of a few images showing the neuroanatomical pathway would have made it easy to understand. The chapter on visual dysfunctions deals with the visual symptoms in relation to the optic nerve pathway and also covers various visual phenomena.

One of the important aspects of stroke clinical diagnosis is differentiating between anterior and posterior circulation strokes. The chapter on dizziness and vertigo explains the clinical clues in localising posterior circulation strokes in relation to the presence of dizziness and vertigo. The chapter “Impaired Consciousness”, covers the various types of disturbances in consciousness. Also, the coma like states which are important in the prediction of prognosis in stroke patients have been discussed. The chapter on language disorders in stroke is very simple and easy to understand. The common language dysfunctions in stroke are discussed well. The section on memory dysfunction is short and crisp.

One of the intriguing aspects of stroke is right hemisphere syndromes. Although the symptomatologies of right hemisphere stroke have been enumerated, this section could have been organized better to improve readability. Vascular cognitive impairment (VCI) is an important post-stroke disability. Post-stroke dementia and cognitive impairment are covered well including the various criteria used for the diagnosis of VCI. One of the neglected disabilities is anxiety and depression after stroke. The chapter on mood disorders contains the risk factors for anxiety and depression after stroke. In addition, the authors have elaborated on the diagnosis and treatment of these conditions.

Stroke disconnection syndromes such as apraxia, agnosia, etc, are described in detail. The common disconnection syndromes are also explained well. Autonomic dysfunctions in stroke are commonly seen. The salient autonomic syndromes that occur following stroke are highlighted along with explanation on the neuroanatomical correlates. Another common speech disorder which occurs in stroke is dysarthria/mutism which can vary according to the site of the lesion and this section also is well covered. The pathophysiology, diagnosis and treatment of post-stroke dysphagia are discussed in a comprehensive manner including the various tools used to evaluate dysphagia. Certain strokes can present with breathing difficulties. The physiology, pathophysiology and clinical syndromes of ventilatory disorders are dealt with methodically. The chapter on lacunar strokes describes the different types of lacunar syndromes and also focus on the pathogenesis and outcome in these patients.

The second section of the book begins with a lucid chapter on arterial territories of the brain. Brain maps of various territories in the cerebrum, brainstem and cerebellum are included. The territories depict the neuroimaging sections in clinical practice. This section lays down the foundation for the remaining chapters of the book. All the chapters begin with basic anatomy, aetiology and then elaborate the clinical features. The chapters on thalamic, caudate and putaminal infarcts/haemorrhages are very informative.

The pathophysiology of lobar haemorrhage including the mechanisms of raised intracranial tension is explained clearly. The chapter on subarachnoid and intraventricular haemorrhage gives an overview of the two important conditions. The large hemispheric infarction deals with the current concepts in pathophysiology and also about the recent surgical trials. There is some degree of repetition in the chapters on midbrain, pontine and medullary strokes. The presentations, aetiologies and prognosis of cerebellar strokes are appropriate. The strokes in the territories of vertebral, basilar and carotid arterial occlusions are described very well. Finally, the last last two chapters also discuss venous ischaemic and spinal cord syndromes.

In the era of modern technology where less importance is given for bedside skills, this book will be a great asset to neurology residents, neurologists and stroke neurologists/physicians.