Brain Embolism

by Caplan; Louis R.

• ISBN13: 9780824729295
• ISBN10: 0824729293
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-07-11
• Publisher: CRC Press

Summary

The only source to fully cover every aspect of brain embolism, this guide analyzes the causes, symptoms, diagnosis, and management of this disorder-providing a detailed overview of major topics pertinent to embolism including donor sources, recipient sites, embolic material, recipient brain supply arteries, vascular and brain pathology, and the treatment of cardiac and arterial sources. Clearly guiding readers through key anatomical structures, diagnostic developments, therapeutic advances, and best practices in clinical care, this source will serve as a must-have desk reference for any clinician in the field.

Table of Contents

Preface	iii
Contributors	xi
Part I: Historical Background and Overview
Historical Background: Development of Ideas and Knowledge about Stroke and Brain Embolism	1	(24)
Louis R. Caplan
Early Writers---Description of Apoplexy and Interest in Anatomy	1	(2)
The 18th Century: Morgagni---The Beginning of Modern Pathology	3	(1)
The First Half of the 19th Century---Recognition of Brain Infarction and a Relationship with Heart Disease	4	(3)
The Second Half of the 19th Century---Cardiac Embolism Becomes an Established Clinical Entity	7	(1)
The First Half of the 20th Century---An Emphasis on Vascular Anatomy	8	(5)
Data Banks and Stroke Registries	13	(4)
New Technology and Further Studies Clarify More Potential Donor Sources of Emboli	17	(1)
Brain and Vascular Investigations Bring Embolism to the Forefront as the Major Cause of Brain Infarction	18	(1)
References	19	(6)
Overview: The Major Components of Brain Embolism	25	(6)
Louis R. Caplan
The Recipient Arteries	25	(2)
The Embolic Material	27	(1)
The Donor Source	28	(1)
References	29	(2)
Part II: Recipient Arteries and Brain Ischemia
Recipient Artery: Anatomy and Pathology	31	(30)
Louis R. Caplan
Examining Recipient Arteries to Separate Embolism and Thrombosis	31	(2)
Hemorrhagic Infarction	33	(3)
Location, Types, and Size of Embolic Brain Infarcts	36	(22)
References	58	(3)
Recipient Artery: Clinical Symptoms and Signs of Brain Ischemia	61	(20)
Louis R. Caplan
General Clinical Features and Diagnosis	61	(6)
Anterior Carotid Artery Circulation Embolism	67	(3)
Posterior Circulation Vertebro-Basilar Arteries Embolism	70	(7)
References	77	(4)
The Eye as the Recipient Artery	81	(12)
Louis R. Caplan
Anatomy of the Arteries that Supply the Eye	81	(2)
Clinical Symptoms and Signs of Eye Ischemia	83	(4)
Methods of Investigating the Eye as a Recipient Site of Embolism	87	(1)
Differential Diagnosis of Retinal Embolism	88	(1)
Usual Sources of Retinal Embolism	89	(1)
Treatment	90	(1)
References	90	(3)
Imaging Evaluation: Recipient Artery Sites	93	(20)
Louis R. Caplan
Brain Neuroimaging	93	(4)
Intracranial Vascular Imaging	97	(4)
Magnetic Resonance Perfusion Imaging and Complete Magnetic Resonance Protocols	101	(3)
Computed Tomography Perfusion and Complete Computed Tomography Protocols	104	(2)
Other Techniques for Studying Perfusion	106	(3)
References	109	(4)
Transcranial Doppler Ultrasound	113	(16)
Carlos A. Molina
Andrei V. Alexandrov
Introduction	113	(1)
TCD Diagnosis of Arterial Occlusions	114	(3)
TCD Monitoring During Thrombolysis	117	(4)
Detection of Intracranial Artery Stenosis and Artery-to-Artery Embolism	121	(1)
Emboli Monitoring	122	(1)
Detection of Right-to-Left Shunts	123	(1)
References	124	(5)
Part III: Donor Sources---Nature, Frequency, Recognition
Cardiac Sources of Embolism: The Usual Suspects	129	(32)
Louis R. Caplan
Warren J. Manning
Arrhythmias	130	(1)
Cardiac Valve Disease	131	(1)
Aortic Valve Disease	132	(5)
Infective Endocarditis	137	(2)
Noninfective Fibrous and Fibrinous Endocardial Lesions (Including Valve Strands)	139	(5)
Myocardial and Cardiac Chamber Lesions	144	(3)
Cardiac Myxomas and Other Tumors	147	(1)
Paradoxical Embolism and Cardiac Septal Lesions	148	(3)
References	151	(10)
Cardiac Source of Embolism: Pathophysiology and Identification	161	(26)
Warren J. Manning
Major Sources of Emboli	161	(1)
Left Atrial Anatomy and Imaging	161	(1)
Left Atrial Thrombi	162	(1)
Mitral Stenosis	163	(2)
Atrial Fibrillation	165	(4)
Left Ventricular Thrombi	169	(1)
Myocardial Infarction	170	(1)
Dilated Cardiomyopathy	171	(1)
Prosthetic Valve Thrombi	171	(1)
Aortic Atherosclerosis	171	(1)
Infective Endocarditis	172	(1)
Valvular Calcification	173	(1)
Valve Excrescences	173	(1)
Mitral Annular Calcification	174	(1)
Intracardiac Tumors	174	(1)
Left Atrial Spontaneous Echo Contrast	175	(1)
Abnormalities of the Interatrial Septum	176	(3)
Imaging Procedures	179	(1)
Summary and Recommendations	179	(1)
References	180	(7)
The Aorta as a Donor Source of Brain Embolism	187	(16)
Louis R. Caplan
Early Pathology-Based Reports of Embolism from the Aorta	187	(1)
Aortic Atherosclerosis	187	(4)
Heart Surgery and Aortic Atherosclerosis	191	(3)
Encephalopathy, Cognitive, and Neurobehavioral Abnormalities After Heart Surgery	194	(2)
Imaging of the Proximal Aorta	196	(2)
References	198	(5)
Arterial Sources of Embolism	203	(20)
Louis R. Caplan
Diseases, Pathology, and Pathophysiology	203	(1)
Atherosclerosis	203	(2)
Arterial Dissections	205	(1)
Fibromuscular Dysplasia	205	(3)
Arterial Aneurysms and Dolichoectatic Arteries	208	(1)
Distribution of Arterial Lesions	209	(4)
Relation of Symptoms to Severity of Atherosclerotic Arterial Stenosis	213	(3)
Imaging and Laboratory Evaluation of Potential Donor Sources of Embolism	216	(3)
References	219	(4)
Ultrasound of Cervical Arteries	223	(20)
Michael Hennerici
Hansjoerg Baezner
Michael Daffertshofer
Intima--Media Thickness: The Initial Stage of Arterial Disease	223	(3)
Plaque Development: The Intermediate Stage of Arterial Disease	226	(8)
Plaque Development: The Final Stage	234	(2)
References	236	(7)
Part IV: Pathophysiology
Vascular Hemostasis and Brain Embolism	243	(16)
Gregory J. del Zoppo
Thrombosis and the Pathophysiology of Brain Ischemia	244	(1)
Cerebrovascular Thrombosis	245	(2)
Hemorrhagic Transformation	247	(1)
Stroke and Consumptive Coagulopathy	248	(1)
Platelet Activation	249	(1)
Thrombin Generation	249	(1)
Fibrin Degradation	249	(1)
Endogenous Protective Mechanisms	250	(1)
Cerebrovascular Reservoir	250	(1)
Collateral Circuits	250	(1)
Microvessel-Associated Protection	250	(1)
Endogenous Thrombus Lysis	251	(1)
Vascular Matrix Degradation	251	(1)
Modulation of Thrombin Activity	252	(1)
Microvessel Integrity, Hemostasis, and Selective Neuron Vulnerability	253	(1)
Summary	253	(1)
References	254	(5)
Part V: Embolic Materials
Embolic Particles	259	(18)
Louis R. Caplan
Cardiac-Origin Substances	259	(5)
Arterial Origin Sources	264	(1)
Substances that Originate from Outside the Cardiovascular Systems	264	(1)
Fat Embolism	264	(4)
Air Embolism	268	(1)
Tumor Embolism	269	(1)
Foreign Body Embolism	270	(1)
References	271	(6)
Part VI: Treatment
Treatment of the Acute Embolic Event	277	(12)
Louis R. Caplan
Reperfusion	277	(5)
Anticoagulation	282	(1)
Neuroprotective Agents	283	(1)
Managing Brain Edema and Mass Effect	284	(1)
References	284	(5)
Cardiac Source of Embolism: Treatment	289	(30)
Warren J. Manning
Atrial Fibrillation	289	(1)
New Onset Atrial Fibrillation	289	(8)
Recurrent or Persistent Atrial Fibrillation	297	(1)
Atrial Fibrillation Risk Profile	298	(2)
Combination Therapy	300	(9)
Abnormalities of the Interatrial Septum	309	(2)
References	311	(8)
Treatment of Aortic and Arterial Sources	319	(16)
Louis R. Caplan
Treatment of Aortic Atheromatosis	319	(1)
Treatment of Arterial Source Emboli	320	(3)
Substances that Alter Fibrinogen Concentrations	323	(1)
Anticoagulants	324	(2)
Surgical and Interventional Treatments	326	(2)
References	328	(7)
Part VII: The Future
A Look Towards the Future	335	(6)
Louis R. Caplan
Warren J. Manning
Diagnostic Advances	335	(3)
Therapeutic Advances	338	(1)
Thrombolysis	338	(1)
Mechanical Devices	338	(1)
Antiplatelet Agents	339	(1)
Anticoagulants	339	(1)
Neuroprotectants	340	(1)
Personnel and Systems of Care	340	(1)
Index	341