Since nearly all workers in the stroke field know, or know of, Dr. Caplan, he can be forgiven for the somewhat immodest title of his book. But can one person alone write a comprehensive book on stroke in the 21st century? Osler's Principles and Practice of Medicine (New York, D. Appleton), published in 1892, with all its antiquated ideas (such as the role of overwork in the formation of aortic aneurysm), remained in print for decades.
Today, there is no less than one to two years between the writing and the marketing of a book, and that is just too long. The publishing industry is currently undergoing its greatest upheaval since the time of Gutenberg, and readers avid for state-of-the-art knowledge can find it on the Web as soon as it appears. The other problem inherent in attempts to write about stroke is that the epidemiology is changing as a result of changes in lifestyle and stroke-prevention strategies. Data from early stroke registries are now anachronistic, and our ideas of pathogenesis have undergone a sea change over the past decade or so.
Caplan's Stroke is very much a personal perspective (as Caplan states in the preface); the prose is direct and clear, and the tone is at times almost chatty, which certainly makes for easy reading. A monumental amount of work has gone into the reading and evaluation of the seemingly endless publications on all aspects of stroke syndromes. There have been major changes since the second edition was published in 1993; most (if not all) of the grainy photographs have been expunged. Some of the chalk drawings remain, and some of the ultrasonograms are suboptimal and uninformative.
The book is divided into three parts and wisely avoids coverage of neurophysiologic and neurochemical mechanisms, apart from the basics. Part I, "General Principles," is essentially a basic primer of stroke, with a particularly enjoyable historical introduction. There are clear line drawings of basic abnormalities and good descriptions of available laboratory tests. Treatment of acute stroke in its broadest perspective is discussed in this section, including thrombolytic therapy and neuroprotectants -- an approach that is unusual but effective. Part II, "Stroke Syndromes," deals comprehensively with the acute abnormalities of stroke and covers the spectrum from large-artery occlusions to global ischemia as a result of cardiac arrest. It ranges widely over virtually all aspects of ischemic and hemorrhagic brain damage, is well illustrated, and has a balanced style that is possible only in works written by a single author. Part III, which covers prevention, complications, and rehabilitation, is perhaps the least informative and thus appropriately the shortest section. Most of the effective prevention strategies are discussed in part I.
To return to the original question: Caplan's Stroke is certainly a tour de force. It represents the perspective of a seasoned clinician who has a wealth of experience and wisdom. However, future editions, judging by the pace at which the data base is expanding, will have to incorporate an electronic version, in the form of either a CD-ROM or a specific Web site, which can be updated regularly.
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