SUBCORTICAL STROKE, 2NDEDITION

Abstract

SUBCORTICAL STROKE, 2nd edition Edited by Geoffrey Donnan, Bo Norrving, John Bamford and Julien Bogousslavsky 2002. Oxford: Oxford University Press Price £79.50. pp. 364. ISBN 0‐19‐263157 This is the second edition of Subcortical Stroke which testifies to the contribution this book has made in attempting to clarify this complex issue. It is excellent. Subcortical stroke is the subject of much confusion—some regard this term as synonymous with lacunar stroke, which it most definitely is not. The first edition was in fact called Lacunar and Other Subcortical Infarctions . The new title is more all embracing and without preconceptions. Lacunar stroke has been a helpful concept but in my view it is heaped in so much confusion that the term is better avoided. To the clinician, it should describe specific clinical syndromes: it does not mean a mild or small stroke, the deficit can be severe. For the radiologist, although the advent of MRI has greatly helped our understanding of clinical lacunar syndromes, MRI has unfortunately led to abuse of the term lacunar stroke to describe virtually any small non‐cortical stroke. To the pathologist, there are specific features often involving a single penetrating artery with lipohyalinosis causing a small area of infarction: in less than 5% it may be haemorrhagic. Because the term lacunar has been used to mean different things to different specialists, it is better avoided or best reserved for the precise pathological lesion, and the term subcortical stroke or small deep infarction or haemorrhage used as these are purely anatomical and descriptive and without preconceived prejudices. The terms subcortical stroke or small deep infarction then allow one to consider the pathology and pathogenesis in the same way one thinks of cortical stroke. The book starts with a historical …