BOOK
Stroke E-Book
J. P. Mohr | Philip A. Wolf | Michael A. Moskowitz | Marc R Mayberg | Rudiger Von Kummer | James C. Grotta
(2011)
Additional Information
Book Details
Abstract
First published in 1986 under the editorial direction of Dr. Henry J.M. Barnett, Stroke: Pathophysiology, Diagnosis, and Management continues to provide the dependable, current answers you need to effectively combat the increasing incidence of this disease. Dr. J.P. Mohr, together with new associate editors Philip A. Wolf, James C. Grotta, Michael A. Moskowitz, Marc Mayberg, and Rüdiger von Kummer as well as a multitude of expert contributors from around the world, offer you updated and expanded coverage of mechanisms of action of commonly used drugs, neuronal angiogenesis and stem cells, basic mechanisms of spasm and hemorrhage, prevention of stroke, genetics/predisposing risk factors, and much more, equipping you to understand the latest scientific discoveries and make effective use of the newest approaches to diagnosis and treatment.
- Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke.
- Access the comprehensive, expert clinical guidance you need to recognize the clinical manifestations of stroke, use the latest laboratory and imaging studies to arrive at a diagnosis, and generate an effective medical and surgical treatment plan.
- Make efficient and accurate diagnoses with the aid of abundant full-color CT images and pathology slides.
- Stay up to date on hot topics such as mechanisms of action of commonly used drugs, neuronal angiogenesis and stem cells, basic mechanisms of spasm and hemorrhage, prevention of stroke, genetics/predisposing risk factors, and much more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Stroke: Pathophysiology, Diagnosis,\rand Management | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xxi | ||
| Contents | xxiii | ||
| Section One-Pathophysiology | 1 | ||
| Chapter 1-Vascular Biology and Atherosclerosis of Cerebral Arteries | 3 | ||
| Physiologic Regulation of Cerebrovascular Tone | 3 | ||
| Pathophysiologic Alterations in Cerebral Vessel Function | 6 | ||
| Summary | 12 | ||
| References | 12 | ||
| Chapter 2-The Cerebral Microvasculature and Responses to Ischemia | 16 | ||
| Anatomy of the Cerebral Vasculature | 16 | ||
| The Neurovascular Unit | 16 | ||
| The Blood-Brain Barrier and Matrix Integrity | 16 | ||
| Cerebral Microvessel Responses to Focal Ischemia | 17 | ||
| The Focal No-Reflow Phenomenon and Secondary Injury | 20 | ||
| Angiogenesis | 21 | ||
| Amyloid Deposition and Lipohyalinosis | 22 | ||
| Summary | 23 | ||
| REFERENCES | 23 | ||
| Chapter 3-Mechanisms of Thrombosis and Thrombolysis | 29 | ||
| Thrombus Formation | 29 | ||
| Fibrinolysis | 31 | ||
| Plasminogen Activators | 33 | ||
| Regulation of Endogenous Fibrinolysis | 36 | ||
| Impact of Plasmin Generation on Microvascular Integrity | 36 | ||
| Consequences of Therapeutic Plasminogen Activation | 37 | ||
| Limitations on the Clinical Use of Fibrinolytic Agents | 37 | ||
| Plasminogen Activators in Cerebral Tissue | 37 | ||
| Plasminogen Activators in Experimental Cerebral Ischemia | 37 | ||
| Plasminogen Activators and Recanalization in Ischemic Stroke | 38 | ||
| Plasminogen Activators and Cerebral Hemorrhage | 38 | ||
| References | 39 | ||
| Chapter 4-Cerebral Blood Flow and Metabolismin Human CerebrovascularDisease | 44 | ||
| Methods of Measurement | 44 | ||
| Energy Metabolism and Normal Cerebral Hemodynamics | 46 | ||
| Hemodynamic Effects of Arterial Occlusive Disease | 49 | ||
| Acute Ischemic Stroke | 50 | ||
| Remote Metabolic Effects of Ischemia | 54 | ||
| Intracerebral Hemorrhage | 56 | ||
| Arteriovenous Malformations | 57 | ||
| Aneurysmal Subarachnoid Hemorrhage | 58 | ||
| Conclusions | 59 | ||
| References | 60 | ||
| Chapter 5-Histopathology of Cerebral Ischemia | 68 | ||
| The Biological Levels of Organization and Stroke | 68 | ||
| Selective Neuronal Necrosis versus Infarction | 68 | ||
| Selective Vulnerability | 69 | ||
| Selective Neuronal Necrosis | 69 | ||
| Pannecrosis or Infarction | 71 | ||
| Epilogue | 73 | ||
| References | 73 | ||
| Chapter 6-Molecular and Cellular Mechanismsof Ischemia-Induced Neuronal Death | 75 | ||
| Global Ischemia | 75 | ||
| Focal Ischemia | 75 | ||
| Experimental Models of Global and Focal Ischemia | 76 | ||
| Modalities of Ischemic Cell Death | 79 | ||
| Triggers of Ischemic Cell Death | 88 | ||
| Mechanisms of Ischemic Cell Death | 95 | ||
| References | 101 | ||
| Chapter 7-Apoptosis and Related Mechanisms in Cerebral Ischemia | 107 | ||
| Pathways of Ischemic Cell Death | 107 | ||
| Molecular Mechanisms of Apoptosis | 108 | ||
| Apoptosis in Cerebral Ischemia | 113 | ||
| Apoptosis in Spinal Cord Ischemia | 114 | ||
| Inhibition of Apoptotic Pathways Reduces Ischemic Damage | 115 | ||
| Apoptosis in Human Brain | 115 | ||
| References | 116 | ||
| Chapter 8-Molecular Pathophysiology of White Matter Anoxic-Ischemic Injury | 122 | ||
| White Matter Anatomy and Physiology | 122 | ||
| Model Systems for Studying White Matter Ischemia | 123 | ||
| Effects of Ischemia on White Matter | 125 | ||
| Mechanisms of White Matter Injury | 129 | ||
| Autoprotection in White Matter | 132 | ||
| References | 134 | ||
| Chapter 9-Cerebral Ischemia and Inflammation | 138 | ||
| Cerebral Ischemia, Cytokines, and Inflammation | 138 | ||
| Mechanisms by Which Inflammation Contributes to Ischemic Brain Injury | 138 | ||
| Nitric Oxide and Inducible Nitric Oxide Synthase | 141 | ||
| Cyclooxygenase-2 | 141 | ||
| Danger Sensors: Scavenger Receptors and Toll-like Receptors | 142 | ||
| Transcription Factors Involved in Postischemic Inflammation | 143 | ||
| Inflammatory Mediators and Ischemic Preconditioning | 144 | ||
| From Bench to Bedside | 145 | ||
| Conclusions | 147 | ||
| References | 148 | ||
| Chapter 10-Intracellular Signaling: Mediators and Protective Responses | 154 | ||
| Preconditioning | 154 | ||
| Cellular Maintenance | 158 | ||
| Regeneration and Repair | 158 | ||
| Clinical Implications | 158 | ||
| References | 159 | ||
| Neurogenesis in the Subventricular Zone | 162 | ||
| Proliferation of Neural Stem and Progenitor Cells after Stroke | 162 | ||
| Migration and Survival of Neuroblasts after Stroke | 163 | ||
| Coupling of Neurogenesis and Angiogenesis | 164 | ||
| Angiogenesis, Neurogenesis, and Functional Recovery | 164 | ||
| The Effect of Cell-Based and Pharmacologically Based Therapieson Angiogenesis and Neurogenesis | 164 | ||
| The Effect of Cell and Pharmacologically Based Therapies on Axonal Remodeling | 165 | ||
| Chapter 12 - Genetics and Vascular Biology of Brain Vascular Malformations | 169 | ||
| Etiology and Pathogenesis | 169 | ||
| Mendelian Disease | 171 | ||
| Familial Aggregation | 172 | ||
| Genetic Studies of Nonfamilial AVM | 172 | ||
| Candidate Gene Studies in AVM Patients | 172 | ||
| Beyond Candidate Gene Studies | 173 | ||
| An Alternative Genetic Mechanism for SporadicAVMs | 173 | ||
| Experimental AVM Models | 174 | ||
| Summary and Synthesis of Data Regarding Etiology and Pathogenesis of AVM | 176 | ||
| Cerebral Cavernous Malformations | 176 | ||
| Overview | 176 | ||
| CCM Genetics | 176 | ||
| CCM1/KRIT1 | 178 | ||
| CCM2/MGC4607 | 179 | ||
| CCM3/PDCD10 | 179 | ||
| CCM Pathogenesis | 179 | ||
| Genotype–Phenotype Correlation | 180 | ||
| Summary of CCM Biology and Pathogenesis | 180 | ||
| Other Vascular Malformations | 180 | ||
| Acknowledgments | 181 | ||
| REFERENCES | 181 | ||
| Section two - Epidemiology and Prevention | 187 | ||
| Chapter 13 - Distribution of Stroke: Heterogeneity by Age, Race, and Sex | 189 | ||
| Indices of Stroke Heterogeneity | 189 | ||
| Stroke Mortality | 191 | ||
| Stroke Incidence | 193 | ||
| Stroke Prevalence | 195 | ||
| Chapter 14 - Epidemiology of Stroke | 198 | ||
| Magnitude of the Problem | 198 | ||
| Mortality | 198 | ||
| Cost | 198 | ||
| Incidence of Stroke | 198 | ||
| Frequency of Stroke by Type | 200 | ||
| Silent Stroke | 201 | ||
| Recurrent Stroke | 201 | ||
| Risk Factors for Stroke | 203 | ||
| Atherogenic Host Factors | 203 | ||
| Heart Disease and Impaired Cardiac Function | 208 | ||
| Other Host Factors | 210 | ||
| Environmental Factors | 211 | ||
| Acknowledgments | 215 | ||
| REFERENCES | 215 | ||
| Mortality after Ischemic Stroke | 219 | ||
| Recurrence after Ischemic Stroke | 224 | ||
| Worsening after Ischemic Stroke | 227 | ||
| Cardiac Events after Stroke | 228 | ||
| Stroke Outcome Prediction Models | 229 | ||
| Functional Disability and Handicap after Stroke | 230 | ||
| Quality of Life after Stroke | 231 | ||
| Depression after Stroke | 232 | ||
| REFERENCES | 233 | ||
| Assessing the Risk for a First Stroke | 242 | ||
| Lifestyle Modification | 242 | ||
| Management of Well-Documented Modifiable Risk Factors for Preventinga First Stroke | 245 | ||
| REFERENCES | 249 | ||
| Chapter 17 - Vascular Dementia and Vascular Cognitive Decline | 252 | ||
| Historical Evolution of the Concept of Vascular Dementia | 252 | ||
| Diagnostic Criteria for Vascular Dementia | 252 | ||
| Dementia following Stroke | 253 | ||
| Overlap of Vascular and Neurodegenerative Pathologies | 253 | ||
| Epidemiology | 253 | ||
| Clinical Diagnosis | 253 | ||
| Neuropsychological Assessments of Vascular Cognitive Impairment | 254 | ||
| Pathophysiology of Vascular Cognitive Impairment | 255 | ||
| Imaging Correlates of Vascular Cognitive Impairment | 255 | ||
| Neuropathologic Aspects | 256 | ||
| Prevention of Vascular Cognitive Impairment | 257 | ||
| Treatment of Persons with Clinical Vascular Dementia | 260 | ||
| Control of Vascular Risk Factors | 260 | ||
| Pharmacologic Treatment of Cognitive Impairment | 261 | ||
| Summary | 261 | ||
| REFERENCES | 261 | ||
| Evidence for Heritability for Stroke and Its Subtypes | 268 | ||
| Disorders Associated with Ischemic or Hemorrhagic Stroke | 269 | ||
| Genome-wide Association Studies | 274 | ||
| Apolipoprotein E and Intracerebral Hemorrhage | 275 | ||
| Genetic Risk Factors for Common Ischemic Stroke | 275 | ||
| Genetics for Optimizing Drug Therapy | 275 | ||
| REFERENCES | 276 | ||
| The Global Burden of Disease Studies | 279 | ||
| Methods for Assessing Cause-Specific Mortality in the GBD | 280 | ||
| GBD Estimates of Stroke Mortality at Global, Regional, and Country Level | 280 | ||
| Global Stroke Epidemiology: Data and Methods | 281 | ||
| Assessing Disability Due to Stroke | 283 | ||
| The Global Burden of Stroke in 2004 | 285 | ||
| Assessing the Contribution of Stroke Risk Factors | 285 | ||
| Projections of Stroke Mortality and Burden from 2004 to 2030 | 286 | ||
| Discussion and Conclusions | 287 | ||
| REFERENCES | 288 | ||
| Section three - Clinical Manifestations | 291 | ||
| Chapter 20 - Classification of Ischemic Stroke | 293 | ||
| Forms of Infarction: Bland and Hemorrhagic | 293 | ||
| Problems in the Diagnosis of Infarction | 293 | ||
| Subtypes of Ischemic Stroke | 295 | ||
| Embolism Attributed to Cardiac Sources | 297 | ||
| Lacunar Infarction | 299 | ||
| Cryptogenic Infarction or Infarct of Undetermined Cause | 301 | ||
| REFERENCES | 302 | ||
| Chapter 21 - Clinical Scales to Assess Patients with Stroke | 307 | ||
| Desired Qualities of Stroke Scales | 307 | ||
| Emergency Medical Services Scales | 309 | ||
| Scales to Differentiate Hemorrhagic Stroke from Ischemic Stroke | 311 | ||
| Differentiation of Ischemic Stroke Syndromes | 311 | ||
| Scales to Quantify the Severity of Hemorrhagic Stroke | 312 | ||
| Scales to Quantify the Severity of Subarachnoid Hemorrhage | 313 | ||
| Scales to Quantify the Severity of Ischemic Stroke | 313 | ||
| Systems to Differentiate the Cause of Ischemic Stroke | 317 | ||
| Measures to Assess Responses to Rehabilitation Interventions | 321 | ||
| Scales to Rate Outcomes (Disability) after Stroke | 321 | ||
| Scales to Rate Outcomes (Global or Handicap) after Stroke | 322 | ||
| Scales to Assess the Quality of Life after Stroke | 323 | ||
| REFERENCES | 326 | ||
| Chapter 22 - Carotid Artery Disease | 334 | ||
| Carotid Anatomy and Lesion Development | 334 | ||
| Pathophysiology of Carotid Artery Ischemia | 337 | ||
| Clinical Syndromes | 344 | ||
| Ischemic Stroke from Carotid Artery Disease | 344 | ||
| Reversible Ischemic Neurologic Deficit | 348 | ||
| Transient Ischemic Attacks | 348 | ||
| Asymptomatic Carotid Artery Disease | 353 | ||
| REFERENCES | 355 | ||
| Chapter 23 - Anterior Cerebral Artery Disease | 362 | ||
| Anatomy | 362 | ||
| Symptoms and Signs | 366 | ||
| REFERENCES | 375 | ||
| Chapter 24 - Middle Cerebral Artery Disease | 384 | ||
| Descriptive Terms | 384 | ||
| Histology | 386 | ||
| Pathology | 386 | ||
| Clinical Syndromes of Middle Cerebral Artery Territory Infarction | 389 | ||
| Clinical Syndromes from Infarction of Either Hemisphere | 389 | ||
| Syndromes Referable to Language-Dominant (Usually Left) Hemisphere Infarction | 396 | ||
| Syndromes of Infarction in the Hemisphere Nondominant for Speech and Language | 411 | ||
| References | 416 | ||
| Chapter 25 - Posterior Cerebral Artery Disease | 425 | ||
| Anatomy | 425 | ||
| Vascular Disease | 427 | ||
| Clinical Syndromes | 429 | ||
| REFERENCES | 441 | ||
| Chapter 26 - Vertebrobasilar Disease | 446 | ||
| Anatomy | 446 | ||
| Pathology | 450 | ||
| Pathophysiology | 455 | ||
| Clinical Findings in Patients with Vascular Lesions in Various Locations | 456 | ||
| Clinical Syndromes of Basilar Occlusion | 457 | ||
| Top of the Basilar Artery Occlusion | 460 | ||
| Basilar Branch and Lacunar Disease | 461 | ||
| Occlusion of Long Circumferential Branches of the Basilar Artery | 462 | ||
| Intracranial Vertebral Artery Occlusive Disease | 468 | ||
| Extracranial Vertebral Artery Occlusive Disease | 472 | ||
| Bilateral Vertebral Artery Occlusion | 473 | ||
| Subclavian-Innominate Artery Disease and Subclavian Steal | 473 | ||
| Mobile Thrombus in the Aortic Arch | 474 | ||
| Multiple Infarcts in the Posterior Circulation | 474 | ||
| Low-Flow States with Resultant Borderzone Ischemia in the Posterior Circulation | 474 | ||
| Migraine | 474 | ||
| REFERENCES | 477 | ||
| Chapter 27 - Microangiopathies (Lacunes) | 485 | ||
| Historical Aspects | 485 | ||
| Definitions | 486 | ||
| Pathoanatomy | 486 | ||
| Arteriopathies Underlying Lacunes | 488 | ||
| General Clinical Features | 490 | ||
| Clinical Syndromes | 491 | ||
| Laboratory Studies | 504 | ||
| Prognosis | 507 | ||
| Treatment | 508 | ||
| REFERENCES | 509 | ||
| Chapter 28 - Cerebral Venous Thrombosis | 516 | ||
| Epidemiology | 516 | ||
| Venous Anatomy | 516 | ||
| Pathophysiology | 517 | ||
| Etiology | 518 | ||
| Clinical Aspects | 519 | ||
| Diagnosis | 520 | ||
| Prognosis | 523 | ||
| Treatment | 525 | ||
| Contraception and Future Pregnancies | 527 | ||
| REFERENCES | 527 | ||
| Chapter 29 - Intracerebral Hemorrhage | 531 | ||
| Genetics | 534 | ||
| Pathologic Features and Pathogenesis | 534 | ||
| Brain Imaging | 553 | ||
| General Clinical and Laboratory Features | 554 | ||
| Supratentorial Intracerebral Hemorrhage | 556 | ||
| Hemorrhage Affecting the Brainstem and Cerebellum | 569 | ||
| REFERENCES | 579 | ||
| Chapter 30 - Aneurysmal Subarachnoid Hemorrhage | 589 | ||
| Historical Aspects | 589 | ||
| Epidemiology | 589 | ||
| Pathophysiology | 591 | ||
| Clinical Presentation | 593 | ||
| Radiographic and Diagnostic Testing | 593 | ||
| Searching for the Aneurysm | 594 | ||
| Management | 597 | ||
| Outcomes | 607 | ||
| REFERENCES | 607 | ||
| Chapter 31 - Arteriovenous Malformations and Other Vascular Anomalies | 616 | ||
| Arteriovenous Malformations | 616 | ||
| Other Vascular Malformations and Anomalies | 632 | ||
| Ongoing Clinical Trials | 637 | ||
| REFERENCES | 637 | ||
| Chapter 32 - Spinal Cord Ischemia | 643 | ||
| Historical Aspects | 643 | ||
| Blood Supply to the Spinal Cord | 643 | ||
| Physiology of Spinal Cord Blood Flow | 645 | ||
| Pathology of Spinal Cord Infarction | 646 | ||
| Etiology | 646 | ||
| Clinical Presentation of Spinal Cord Infarction | 650 | ||
| Differential Diagnosis | 652 | ||
| Diagnostic Tests | 652 | ||
| Treatment and Prognosis | 653 | ||
| REFERENCES | 653 | ||
| Section four - Specific MedicalDiseases and Stroke | 659 | ||
| Chapter 33 - Arterial Dissections and Fibromuscular Dysplasia | 661 | ||
| Arterial Dissections | 661 | ||
| Fibromuscular Dysplasia | 675 | ||
| REFERENCES | 680 | ||
| Chapter 34 - Collagen Vascular and Infectious Diseases | 687 | ||
| Giant Cell Arteritis | 687 | ||
| Isolated Angiitis of the Central Nervous System | 689 | ||
| Takayasu’s Arteritis | 691 | ||
| Polyarteritis Nodosa | 692 | ||
| Systemic Lupus Erythematosus | 692 | ||
| Wegener’s Granulomatosis | 693 | ||
| Allergic Angiitis | 693 | ||
| Lymphomatoid Granulomatosis | 693 | ||
| Scleroderma | 693 | ||
| Rheumatoid Arthritis | 693 | ||
| Sneddon’s Syndrome | 694 | ||
| Malignant Atrophic Papulosis | 694 | ||
| Behçet’s Disease | 694 | ||
| Cryoglobulinemia | 695 | ||
| Retinocochleocerebral Vasculopathy (Susac’s Syndrome) | 695 | ||
| The Role of Inflammation in Atherosclerosis and Stroke | 695 | ||
| References | 698 | ||
| Chapter 35 - Moyamoya Disease | 703 | ||
| Guideline For Diagnosis | 703 | ||
| Epidemiology | 703 | ||
| Pathology | 706 | ||
| Etiology and Pathogenesis | 710 | ||
| Clinical Symptoms and Signs | 711 | ||
| Laboratory Findings | 711 | ||
| Clinical Examination | 712 | ||
| Disease Progression and Prognosis | 713 | ||
| Treatment | 713 | ||
| Conclusion and Future Directions | 716 | ||
| References | 716 | ||
| Chapter 36 - Migraine and Stroke | 720 | ||
| Clinical Features | 720 | ||
| Classification | 720 | ||
| Epidemiology | 722 | ||
| Neuroimaging | 724 | ||
| Headache of Vascular Disease | 724 | ||
| Migraine that Mimics Stroke | 725 | ||
| Mechanisms | 727 | ||
| Migraine and Patent Foramen Ovale | 728 | ||
| Stroke Prevention in Patients with Migraine | 729 | ||
| Treatment of Migraine in Patients at Risk for Stroke or in Patients with Transient Ischemic Attack or Stroke | 729 | ||
| References | 730 | ||
| Chapter 37 - Hypertensive Encephalopathy | 734 | ||
| Pathogenesis | 734 | ||
| Pathologic Features | 735 | ||
| Clinical Features | 735 | ||
| Neuroradiologic Features | 735 | ||
| Causes | 737 | ||
| Treatment | 738 | ||
| References | 739 | ||
| Chapter 38 - Atherosclerotic Disease of the Proximal Aorta | 741 | ||
| Frequency of Aortic Plaques in the General Population | 741 | ||
| Aortic Plaques and Ischemic Stroke | 741 | ||
| Natural History of Aortic Plaques | 747 | ||
| Aortic Plaques and Atheroembolism | 747 | ||
| Factors Associated with Aortic Plaques in Patients with Stroke | 747 | ||
| Proximal Aortic Plaques and Carotid Artery Disease | 749 | ||
| Proximal Aortic Plaques and Coronary Artery Disease | 749 | ||
| Aortic Plaques and Atheroembolism | 749 | ||
| Treatment of Proximal Aortic Plaques | 751 | ||
| Future Directions | 752 | ||
| Summary | 753 | ||
| REFERENCES | 754 | ||
| Chapter 39 - CADASIL: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy | 758 | ||
| History | 758 | ||
| Clinical Presentation | 759 | ||
| Neuroimaging | 760 | ||
| Pathology | 760 | ||
| Genetics | 761 | ||
| Diagnosis | 762 | ||
| Conclusion | 762 | ||
| REFERENCES | 763 | ||
| Chapter 40 - Reversible Cerebral Vasoconstriction Syndromes | 765 | ||
| History, Evolution, and Associated Conditions | 765 | ||
| Demographics and Clinical Features | 767 | ||
| Laboratory Findings | 767 | ||
| Brain Imaging | 767 | ||
| Differential Diagnosis | 769 | ||
| Etiology and Pathophysiology | 769 | ||
| Management | 770 | ||
| Outcome and Prognosis | 770 | ||
| REFERENCES | 770 | ||
| Chapter 41 - Coagulation Abnormalities in Stroke | 772 | ||
| Pathogenesis of Thrombosis | 772 | ||
| Homocystinuria and Homocystinemia | 780 | ||
| Sickle Cell Disease | 782 | ||
| Screening of Patients with Stroke for Coagulopathies | 783 | ||
| References | 784 | ||
| Chapter 42 - Stroke and Substance Abuse | 790 | ||
| Opiates | 790 | ||
| Amphetamine and Related Agents | 792 | ||
| Cocaine | 795 | ||
| Phencyclidine | 797 | ||
| Lysergic Acid Diethylamide | 797 | ||
| Marijuana | 797 | ||
| Barbiturates | 798 | ||
| Inhalants | 798 | ||
| Alcohol | 798 | ||
| Tobacco | 800 | ||
| REFERENCES | 802 | ||
| Chapter 43 - Cardiac Diseases | 814 | ||
| Clinical Features of Cardioembolic Transient Ischemic Attack or Stroke | 814 | ||
| Diagnostic Studies | 815 | ||
| Approach to Management | 816 | ||
| Specific Cardiac Conditions Causing Cerebral Embolism | 816 | ||
| REFERENCES | 823 | ||
| Section five - Diagnostic Studies | 829 | ||
| Chapter 44 - Ultrasonography | 831 | ||
| Ultrasound Technology | 831 | ||
| Monitoring Early Atherosclerosis | 833 | ||
| Nonatherosclerotic Vascular Disease | 841 | ||
| Transcranial Doppler in the Evaluation of Stroke | 842 | ||
| Stroke Therapy with Ultrasound | 855 | ||
| Emerging Applications | 858 | ||
| REFERENCES | 860 | ||
| Chapter 45 - Computed Tomography–Based Evaluation of Cerebrovascular Disease | 870 | ||
| Noncontrast CT | 870 | ||
| CTA | 873 | ||
| CT Perfusion Imaging | 877 | ||
| Posterior Circulation CT Imaging | 878 | ||
| NCT and CTA in Acute Hemorrhagic Stroke | 878 | ||
| REFERENCES | 879 | ||
| Chapter 46 - Magnetic Resonance Imaging of Cerebrovascular Diseases | 882 | ||
| General Principles and Basic Pulse Sequences | 882 | ||
| Stroke MRI Examination | 888 | ||
| Transient Ischemic Attacks | 889 | ||
| Ischemic Stroke | 891 | ||
| Hemorrhage | 895 | ||
| Vascular Pathology | 898 | ||
| MRI-Guided Acute Stroke Therapy | 900 | ||
| References | 902 | ||
| Chapter 47 - Cerebral Angiography | 910 | ||
| Technique | 910 | ||
| Risks | 910 | ||
| Angiographic Cerebral Vasculature: Normal Anatomy | 911 | ||
| Indications | 911 | ||
| REFERENCES | 924 | ||
| Section six - Therapy | 927 | ||
| PART A • MEDICAL THERAPY | 929 | ||
| Chapter 48 - Prehospital and Emergency Department Care of the Patient with Acute Stroke | 929 | ||
| The Course of Events for the Acute Stroke Patient | 929 | ||
| Recognition of Stroke Symptoms by the Patient or Family Members | 930 | ||
| First Contact with Medical Care | 930 | ||
| Dispatch of Appropriate Level of Prehospital Providers | 931 | ||
| Prehospital Evaluation and Management | 931 | ||
| Prehospital Identification of Stroke | 932 | ||
| Prehospital Notification of Pending Emergency Department Arrival | 932 | ||
| Emergency Department Time Delays | 932 | ||
| Emergency Department Triage | 934 | ||
| Emergency Department Evaluation and Management | 934 | ||
| Divergence of Pathways Based on Ischemic Versus Hemorrhagic Stroke | 937 | ||
| Disposition from the Emergency Department | 941 | ||
| Conclusion | 942 | ||
| REFERENCES | 942 | ||
| Chapter 49 - Intravenous Thrombolysis | 945 | ||
| Preclinical Studies of Thrombolysis for Acute Stroke | 950 | ||
| Clinical Studies of Thrombolysis for Acute Stroke | 951 | ||
| Community Experience of Thrombolysis for Acute Stroke | 957 | ||
| Guidelines for Intravenous Thrombolysis in Acute Stroke | 960 | ||
| Combination Treatment | 967 | ||
| Conclusion | 968 | ||
| REFERENCES | 968 | ||
| Chapter 50 - Antithrombotic Therapy for Treatment of Acute Ischemic Stroke | 971 | ||
| Pharmacology | 971 | ||
| Safety of Emergency Antithrombotic Treatment for Patients with AcuteIschemic Stroke | 975 | ||
| Efficacy of Treatment of Acute Ischemic Stroke | 979 | ||
| Prevention of Deep Vein Thrombosis | 985 | ||
| Other Indications | 985 | ||
| Current Status of Antithrombotic Therapy | 986 | ||
| Future of Antithrombotic Therapy | 986 | ||
| REFERENCES | 987 | ||
| Chapter 51 - General Stroke Management and Stroke Units | 992 | ||
| Short History of Stroke Units | 992 | ||
| Stroke Unit Design | 992 | ||
| Effectiveness of Stroke Unit Care | 993 | ||
| Who Benefits? | 995 | ||
| Are There Long-Term Benefits of Stroke Unit Care? | 995 | ||
| Availability of Stroke Unit Care | 996 | ||
| General Stroke Management | 996 | ||
| Conclusions | 1004 | ||
| REFERENCES | 1004 | ||
| Chapter 52 - Critical Care of the Patient with Acute Stroke | 1008 | ||
| General Principles of Neurologic Critical Care | 1008 | ||
| Specific Treatment of Various Stroke Syndromes | 1024 | ||
| References | 1039 | ||
| Chapter 53 - Pharmacologic Modification of Acute Cerebral Ischemia | 1049 | ||
| Background: Preclinical and Clinical Cytoprotection | 1049 | ||
| Clinical Cytoprotective Therapy Trials | 1055 | ||
| Conclusion | 1075 | ||
| REFERENCES | 1075 | ||
| Chapter 55 - Medical Therapy of Intracerebral and Intraventricular Hemorrhage | 1106 | ||
| Emergency Department Management | 1106 | ||
| The Importance of Aggressive Medical Therapies | 1106 | ||
| Prevention of Rebleeding | 1108 | ||
| Management of Cerebral Edema, Hydrocephalus, and Intraventricular Hemorrhage | 1109 | ||
| Special Considerations in Warfarin-Related Intracranial Hemorrhage | 1111 | ||
| Selection of Patients for Surgery | 1111 | ||
| Predictors of Outcome and Withdrawal of Care | 1112 | ||
| Conclusions | 1113 | ||
| REFERENCES | 1113 | ||
| Neurologic Rehabilitation | 1116 | ||
| Chapter 57 - Enhancing Stroke Recovery with Cellular Therapies | 1134 | ||
| What Are the Goals of Cell-Based Therapy for Stroke? | 1134 | ||
| The Complexity of Stroke for Cell Therapy | 1134 | ||
| The Complexity of Cells | 1135 | ||
| Mechanisms | 1140 | ||
| Pilot Clinical Trials: Lessons Learned | 1141 | ||
| Recent and Ongoing Studies | 1141 | ||
| Translational Barriers | 1142 | ||
| Guidelines: Stem Cell Therapies as an Emerging Paradigm in Stroke | 1144 | ||
| Conclusion | 1144 | ||
| Chapter 58 - Antiplatelet Therapy for Secondary Prevention of Stroke | 1147 | ||
| Platelet Function in Patients at Risk of Occlusive Stroke | 1153 | ||
| Antiplatelet Drugs and Prevention of Stroke | 1154 | ||
| Combinations of Antiplatelet Agents | 1164 | ||
| Other Antiplatelet Agents | 1167 | ||
| Antiplatelet and Cerebral Microbleeds | 1167 | ||
| Conclusions | 1168 | ||
| REFERENCES | 1168 | ||
| Chapter 59 - Secondary Prevention of Cardioembolic Stroke | 1173 | ||
| Atrial Fibrillation | 1173 | ||
| Cardiomyopathies | 1176 | ||
| Myocardial Infarction | 1177 | ||
| Valvular Heart Disease | 1178 | ||
| Prosthetic Cardiac Valves | 1179 | ||
| Nonbacterial Thrombotic Endocarditis | 1180 | ||
| Infectious Endocarditis | 1180 | ||
| Cardiac Tumors | 1180 | ||
| Patent Foramen Ovale | 1180 | ||
| Aortic Arch Disease | 1182 | ||
| Anticoagulant Agents | 1182 | ||
| Intracerebral Hemorrhage Associated with Anticoagulation | 1184 | ||
| Anticoagulation in Acute Cardioembolic Stroke | 1185 | ||
| Resumption of Anticoagulation in the Presence of Intracerebral Hemorrhage | 1186 | ||
| Summary | 1186 | ||
| References | 1186 | ||
| Chapter 60 - Conduct of Stroke-Related Clinical Trials | 1192 | ||
| Prevention Trials | 1192 | ||
| Therapeutic Trials | 1192 | ||
| When Can a Stroke-Related Trial Be Conducted? | 1192 | ||
| The Three Phases of Clinical Trials | 1193 | ||
| Outcome Measures | 1194 | ||
| Sample Size | 1194 | ||
| Adaptive Designs | 1195 | ||
| INDEX | 1447 |