Cerebrovascular Diseases. Thirteenth Research (Princeton) Conference

255 be of little help to the reader interested in learning more about a particular aspect of the disease. In spite of these shortcomings, however, this book could be of use to the patient with multiple sclerosis. Practical advice for coping with everyday problems and frank discussion of "touchy" subjects could be invaluable to the patient who feels overwhelmed by the disease. and others-took part in the conference. Both basic research and clinical papers are presented. The initial portion of the book contains a brief overview of the mechanism of NMR, as well as present and potential uses of NMR and PET scanning in cerebrovascular disease. Both modalities represent potential quantum leaps in research and clinical management of stroke patients. PET scanning appears to be the current test of choice for evaluation of cerebral tissue blood flow and metabolism. Abstracts of some of the discussions that followed the presentations are presented throughout the book and are, in general, quite pertinent. For example, the discussion concerning the potential dangers of metallic objects-notably ferromagnetic-on or in the body of a patient undergoing an NMR scan is of interest and clinically significant. The second major section of this book deals with prognostic indicators in cere-brovascular disease. Many of these articles contain important clinical implications. Some of the more notable presentations merit brief mention. The significant decrease in stroke mortality, especially over the past 15 years, is felt to be a direct result of improved therapy of heart disease and hypertension. A most interesting article by Norris and D'Alton concludes that current published data on surgical versus conservative management of the asymptomatic carotid bruit is inadequate to decide on correct therapeutic management. Age, hypertension, heart disease, and diabetes are noted as the most important risk factors in both transient ischemic attacks (TIAs) and stroke. Another presentation notes that there is no clear-cut evidence as to which of various treatment modalities is superior for acute cerebral infarction in evolution. Four factors which were seen as clinical predictors of stroke severity in a prospective study at the New York Hospital were: (1) degree of focal neurological deficit, (2) level of sensorium, (3) decrease in brain density on CT scan, and (4) blood sugar level on hospital admission. Location and type of stroke also correlate with the severity of residual deficits, and post-stroke affective disorders are common, especially depression. A comparative review of the results of therapy …