Ischemic Cerebrovascular Disease

by Adams, Jr., Harold P.; Hachinski, Vladimir C.; Norris, John W.

• ISBN13: 9780195132892
• ISBN10: 0195132890
• Format: Hardcover
• Copyright: 2001-08-02
• Publisher: Oxford University Press

Summary

This book provides a comprehensive clinical review of the diagnosis and treatment of patients with ischemic cerebrovascular disease. The book includes chapters on the clinical features of transient ischemic attacks and ischemic stroke, risk factors, and evaluations. Additional chapters discusscauses of stroke including atherosclerosis, cardioembolism, non-atherosclerotic vasculopathies, and pro-thrombotic disorders. The causes of stroke in children and young adults are highlighted. The final section of the book includes chapters on therapies to prevent stroke, acute stroke treatment,general management of the patient with recurrent stroke, and rehabilitation. The volume is heavily referenced with an emphasis on recent publications so that the reader can pursue additional information about a topic. It also includes several tables and algorithms that should aid the cliniciantreating patients with cerebrovascular disease.

Table of Contents

Introduction to Ischemic Cerebrovascular Disease	1	(28)
Ischemic Stroke as A Public Health Problem	1	(3)
Mortality
Disability
Economic Consequences of Stroke
Health Care Systems
Stroke Advocacy
Future Trends
Terminology And Classification Of Ischemic Stroke	4	(4)
General Terms
Types of Ischemic Events
Vascular Infrastructure	8	(7)
Ischemic Stroke As A Symptom	15	(2)
Pathophysiology of Ischemic Stroke	17	(4)
Prognosis	21	(8)
Epidemiology of Ischemic Stroke	29	(28)
Non-Modifiable Risk Factors	29	(7)
Age
Sex
Ethnicity and Geography
Social and Economic Status
Family History of Vascular Disease
Environmental Factors
Common Potentially Controllable Risk Factors	36	(8)
Arterial Hypertension
Diabetes Mellitus
Elevated Blood Lipids
Obesity
Other Dietary Factors
Physical Inactivity
Hyperhomocystinemia
Tobacco Use
Alcohol Use
Drug Abuse
Post-menopausal Use of Estrogens
Oral Contraceptives
Migraine
Other Risk Factors	44	(1)
Infections
Snoring, Sleep Apnea, and Pulmonary Disease
Symptomatic Disease In Other Arterial Territories	45	(1)
Heart Disease	45	(12)
Presentations of Ischemic Stroke and Transient Ischemic Attack	57	(46)
Transient Ischemic Attack	58	(8)
Keys to Diagnosis of Transient Ischemic Attack
Differentiating Symptoms in Carotid or Vertebrobasilar Circulations
Symptoms of Carotid Arterial Circulation
Vertebrobasilar Arterial Circulation
Examination of Patients with Suspected Transient Ischemic Attack
Diagnosis of Ischemic Stroke	66	(6)
Clinical Features of Ischemic Stroke
Differential Diagnosis of Ischemic Stroke
Examination of Patients with Ischemic Stroke
Stroke Scales
Manifestations of Ischemic Stroke of The Cerebral Hemispheres	72	(16)
Internal Carotid Artery Occlusion
Proximal Middle Cerebral Artery Occlusion
Striatocapsular and Subcortical Lacunar Infarction
Occlusion of the Bifurcation of the Middle Cerebral Artery
Insular Infarction
Occlusion of Branches of the Middle Cerebral Artery
Borderzone Infarction
Centrum Semiovale Infarction
Anterior Choroidal Artery Occlusion
Anterior Cerebral Artery Occlusion
Posterior Cerebral Artery Occlusion
Thalamic Infarction and Top-of-the-Basilar Occlusion
Posterior Choroidal Artery Occlusion
Manifestations Of Ischemic Stroke In The Brain Stem And Cerebellum	88	(6)
Medullary Infarction and Posterior Inferior Cerebellar Artery Occlusion
Pontine Infarction and Anterior Inferior Cerebellar Artery Occlusion
Basilar Artery Occlusion
Mesencephalic Infarction and Superior Cerebellar Artery Occlusion
Cerebellar Infarction
Lacunar Syndromes	94	(9)
Evaluation Of The Patient With A Transient Ischemic Attack Or An Ischemic Stroke	103	(56)
General Principles	103	(1)
Imaging Of The Brain	104	(13)
Computed Tomography
Magnetic Resonance Imaging
Other Neurological Diagnostic Tests	117	(1)
Electroencephalography
Cerebrospinal Fluid Examination
Assessment Of Cerebral Blood Flow And Brain Metabolism	118	(2)
Positron Emission Tomography
Single Photon Emission Computed Tomography
Functional Computed Tomography
Magnetic Resonance Imaging Spectroscopy
Imaging Of Extracranial And Intracranial Arteries	120	(12)
Arteriography and Digital Subtraction Angiography
Digital Intravenous Subtraction Angiography
Carotid Artery Duplex
Ultrasonography of the Vertebral and Cervical Arteries
Other Non-invasive Studies of the Carotid Circulation
Transcranial Doppler Ultrasonography
Magnetic Resonance Angiography
Computed Tomography Angiography
Evaluation Of The Heart	132	(3)
Electrocardiography and Chest X-ray
Cardiac Rhythm Monitoring
Studies to Screen for Coronary Artery Disease
Cardiac Imaging For A Source Of Emboli	135	(7)
Transthoracic Echocardiography
Transesophageal Echocardiography
Ultrafast Computed Tomography Imaging of the Heart
Magnetic Resonance Imaging of the Heart
Other Diagnostic Tests	142	(17)
Atherosclerotic Cerebrovascular Disease	159	(30)
General Features Of Atherosclerosis	159	(4)
Course of Atherosclerosis
Fracturing of the Cap and Acute Thrombosis
Hypoperfusion
Clinical Presentations Of Cerebrovascular Atherosclerosis	163	(1)
Large Artery Atherosclerosis	163	(16)
Internal Carotid Artery Stenosis or Occlusion
Asymptomatic Carotid Artery Bruit
Asymptomatic Carotid Artery Plaque or Stenosis
Middle Cerebral Artery Stenosis
Other Sites of Intracranial Arterial Stenosis
Binswanger Disease
Basilar Artery Stenosis
Dolichoectasia of the Basilar Artery
Vertebral Artery Atherosclerosis
Atherosclerosis of the Great Vessels Arising from the Arch of the Aorta
Atherosclerosis of the Arch of the Aorta
Dissection of the Ascending Aorta
Other Atherosclerotic Disease of the Aorta
Small Vessel Occlusive (Lacunar) Disease	179	(10)
Lacunar Syndromes
Lacunar Stroke
Treatment
Cardiac Sources Of Embolism	189	(31)
Categories Of Heart Disease That Lead To Embolism	190	(2)
Higher- and Lower-Risk Cardiac Diseases
Atrial Fibrillation	192	(5)
Higher- and Lower-Risk Situations
Echocardiographic Findings
Sustained or Intermittent Atrial Fibrillation
Management of Atrial Fibrillation
Prevention of Embolism
Coronary Artery Disease	197	(3)
Acute Myocardial Infarction
Ventricular Aneurysm and Ischemic Cardiomyopathy
Congenital Heart Disease	200	(1)
Cyanotic Congenital Heart Disease
Patent Foramen Ovale
Atrial Septal Aneurysm
Valvular Heart Disease	201	(2)
Rheumatic Valvular Disease
Mitral Valve Prolapse
Mitral Annulus Calcification
Aortic Valve Calcification and Aortic Stenosis
Prosthetic Heart Valves
Other Cardiac Conditions	203	(4)
Infective Endocarditis
Non-bacterial Thrombotic Endocarditis
Libman-Sacks Endocarditis
Atrial Myxoma
Dilated Cardiomyopathy
Idiopathic Hypertrophic Subaortic Stenosis
Cardiac Abnormalities Detected During Evaluation	207	(1)
Spontaneous Echocardiographic Contrast
Valvular Strands
Lambl's Excrescence
Cardiovascular Procedures	207	(2)
Cardiac Catheterization and Coronary Arteriography
Left Ventricular Assist Devices
Coronary Artery Bypass Graft Surgery and Other Cardiac Operations
Cardiac Transplantation
Non-Cardiac Or Non-Thrombotic Causes Of Embolism	209	(11)
Air Embolism
Fat Embolism
Amniotic Fluid Embolism
Other Types of Embolism
Pulmonary Arteriovenous Malformation
Non-Atherosclerotic Vasculopathies	220	(34)
Non-Inflammatory Vasculopathies	221	(16)
Arterial Dissection
Arterial Injuries
Radiation-Induced Vasculopathy
Fibromuscular Dysplasia
Buerger Disease
Intracranial Saccular Aneurysms
Pseudoxanthoma Elasticum
Moyamoya Disease and Moyamoya Syndrome
Infectious Vasculopathies	237	(3)
Syphilis
Acquired Immune Deficiency Syndrome
Herpes Zoster
Cysticercosis
Bacterial and Fungal Meningitis
Aspergillosis
Mucormycosis
Cat-Scratch Disease
Malaria
Whipple Disease
Behcet Disease
Inflammatory, Non-Infectious Vasculopathies	240	(14)
Isolated Central Nervous System Vasculitis
Cogan Syndrome
Eale Disease
Periarteritis Nodosa
Wegener Disease
Churg-Strauss Angiitis
Takayasu Disease
Giant Cell Arteritis
Sjogren Syndrome
Systemic Lupus Erythematosus
Scleroderma
Rheumatoid Arthritis
Inflammatory Bowel Disease
Sarcoidosis
Pro-Thrombotic States	254	(27)
General Features Of Pro-Thrombotic Diseases	255	(3)
General Clinical Features
Frequency of Hypercoagulable Causes of Ischemic Stroke
Cellular Pro-Thrombotic Disorders	258	(3)
Polycythemia
Anemia
Sickle Cell Disease
Thrombocytosis
Thrombotic Thrombocytopenia Purpura/Hemolytic-Uremic Syndrome
Heparin-Associated Thrombocytopenia
Leukemia
Pro-Thrombotic Disorders Of Plasma Proteins	261	(8)
Decreased Protein C Activity
Decreased Protein S Activity
Decreased Antithrombin III Activity
Factor V Leiden/Activated Protein C Resistance
Prothrombin G20210A Mutation
Deficiency of Heparin Cofactor II
Deficiency of Plasminogen
Increased Fibrinogen Concentration
Thalassemia
Carbohydrate-Deficient Glycoprotein Syndrome
Waldenstrom Macroglobulinemia
Antiphospholipid Antibodies/Lupus Anticoagulant
Warfarin-Induced Skin Necrosis
Disseminated Intravascular Coagulation
Other Disorders of Coagulation
Hypercoagulable States Secondary To Other Conditions	269	(12)
Pregnancy and Puerperium
Oral Contraceptives
Cancer and Chemotherapy
Dehydration
Inflammatory Bowel Disease
Paroxysmal Nocturnal Hemoglobinuria
Nephrotic Syndrome
Sepsis and Inflammation
Other Diseases
Stroke In Children And Young Adults And Genetic Causes Of Stroke	281	(30)
Ischemic Stroke In Childhood	283	(3)
Arterial Diseases
Pro-thrombotic Conditions
Cardioembolism
Prognosis
Ischemic Stroke In Young Adults	286	(2)
Atherosclerosis
Non-atherosclerotic Vascular Diseases
Cardioembolism
Pro-thrombotic Conditions
Prognosis
Causes Of Stroke Largely Restricted To Young Adults	288	(10)
Susac Syndrome
Migraine
Pregnancy and Puerperium
Oral Contraceptives
Alcohol Abuse
Illicit Drug Abuse
Stroke Complicating Use of Medications
Genetic Causes Of Ischemic Stroke	298	(13)
Homocystinuria
Fabry-Anderson Disease
Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes
Kearns-Sayre Syndrome and Other Mitochondrial Diseases
Cerebral Autosomal Dominant Arteriopathy and Subcortical Ischemic Leukoencephalopathy
Other Genetic Diseases
Inherited Connective Tissue Disorders
Stroke as a Complication of Other Inherited Diseases
Medical Therapy For Prevention Of Ischemic Stroke	311	(62)
General Principles In Prevention Of Ischemic Stroke	311	(5)
Identification of High-Risk Patients
Management of Risk Factors
Prevention of Stroke with the HMG Co A Reductase Inhibitor Medications
Prevention of Ischemic Stroke Among High-Risk Patients	316	(2)
Anticoagulants	318	(1)
Heparin	319	(6)
Pharmacology
Safety
Potential Indications
Summary
Low Molecular Weight Heparins And Danaparoid	325	(1)
Pharmacology
Safety
Potential Indications
Summary
Oral Anticoagulants	326	(14)
Pharmacology
Administration
Safety
Potential Indications
Summary
Other Antithrombotic Agents	340	(1)
Antiplatelet Aggregating Agents	340	(14)
Aspirin
Ticlopidine
Clopidogrel
Dipyridamole
Other Antiplatelet Aggregating Agents
Pentoxifylline	354	(1)
Combinations Of Medications	354	(1)
Combinations of Antiplatelet Aggregating Agents
Combinations of Anticoagulants and Antiplatelet Aggregating Agents
Neuroprotective Agents	355	(1)
Summary And Algorithm For Medical Management	355	(18)
Summary
Algorithm
Surgical Therapy For Prevention Of Ischemic Stroke	373	(32)
Carotid Endarterectomy	373	(14)
Rationale
Procedure
Safety
Potential Indications
Summary
Extracranial-Intracranial Arterial Anastomosis	387	(2)
Rationale
Procedure
Safety
Potential Indications
Summary
Other Surgical Procedures	389	(2)
Cardiac Operations	391	(1)
Angioplasty And Stenting	391	(4)
Rationale
Procedure
Safety
Potential Indications
Summary
Summary And Algorithm For Surgical Management	395	(10)
Summary
Algorithm
Management Of Acute Ischemic Stroke	405	(70)
Brain Attack	407	(1)
Care Prior To Arrival In The Emergency Department	408	(5)
Recognition
Initial Contact, Evaluation, and Transport
Initial Steps In Emergent Care	413	(8)
Acute Stroke Treatment Centers
Stroke Teams
Personnel
Emergency Diagnostic Tests
Clinical Evaluation
Vital Signs
History
General Examination
Neurological Examination
Diagnostic Studies
General Emergent Treatment	421	(5)
ABCs of Life Support
Management of Acute Cardiovascular Complications
Management of Arterial Hypertension
Management of Blood Glucose and Fluids
Management of Acute Neurological Complications
Emergent Treatment Of Acute Ischemic Stroke Itself	426	(1)
Thrombolytic Therapy	427	(16)
Pharmacology and Rationale
Safety
Results of Clinical Trials-Acute Ischemic Stroke
Ancrod
Summary
Guidelines and Algorithm
Anticoagulants	443	(6)
Rationale
Results of Clinical Trials-Acute Ischemic Stroke
Conclusions
Antiplatelet Aggregating Agents	449	(2)
Rationale
Results of Clinical Trials-Acute Ischemic Stroke
Conclusion
Other Medical Interventions To Improve Cerebral Perfusion	451	(3)
Drug-Induced Hypertension
Vasodilators
Hemodilution and Hypervolemia
Results of Clinical Trials-Acute Ischemic Stroke
Conclusion
Surgical And Other Interventions To Improve Cerebral Perfusion	454	(1)
Rationale
Carotid Endarterectomy
Embolectomy
Endovascular Treatment
Conclusion
Neuroprotective Therapies	455	(3)
Results of Clinical Trials-Acute Ischemic Stroke
Other Medications
Conclusion
Subsequent Acute Care	458	(17)
Management Of Hospitalized Patients With Acute Ischemic Stroke	475	(48)
Admission Of Patients To The Hospital	475	(1)
Stroke Units	476	(6)
Components of a Stroke Unit
Activities of a Stroke Unit
Care Maps
Outcomes of Patients Hospitalized in Stroke Units
Conclusion
Neurological Complications Of Ischemic Stroke	482	(15)
Brain Edema and Increased Intracranial Pressure
Large Cerebellar Infarction and Hydrocephalus
Hemorrhagic Transformation of Infarction
Early Recurrent Ischemic Stroke
Seizures
Dementia
Other Neurological Complications
Medical Complications Of Ischemic Stroke	497	(12)
Cardiovascular Complications
Deep Vein Thrombosis and Pulmonary Embolism
Respiratory Failure and Pneumonia
Incontinence, Indwelling Bladder Catheters, and Urinary Tract Infections
Gastrointestinal Complications
Electrolyte Disturbances, Nutrition, and Hydration
Dermatologic and Orthopedic Complications
Depression and Other Psychiatric Disorders
Components Of Treatment In The Hospital	509	(14)
Prevention and Treatment of Complications of Stroke
Evaluation for the Cause of Stroke
Initiation of Treatment to Prevent Recurrent Stroke
Initiation of Rehabilitation
Patient and Family Education
Discharge Planning
Rehabilitation And Recovery After Ischemic Stroke	523	(34)
Guidelines For Rehabilitation	523	(3)
Goals for Rehabilitation
Monitoring Responses to Rehabilitation
Selection Of Patients For Rehabilitation	526	(3)
Location of Stroke and Severity of Neurological Impairments
Interval from Stroke
Co-morbid Diseases
Guidelines
Selection Of Site For Rehabilitation	529	(5)
In-Patient Rehabilitation Unit
Skilled Nursing Facility
Out-Patient Rehabilitation
Individual Rehabilitation Services	534	(8)
Physical Therapy
Treatment of Spasticity
Occupational Therapy
Speech Pathology
Cognitive Rehabilitation
Treatment of Depression
Restorative Therapies	542	(1)
Return To Society	543	(14)
Discharge from Rehabilitation
Patient-Related Issues Including Quality of Life
Family Issues
Home Environment
Returning to Work
Driving
Sexual Dysfunction
Index	557