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دانلود کتاب Stroke: Pathophysiology, Diagnosis, and Management
دانلود کتاب سکته مغزی: پاتوفیزیولوژی، تشخیص و مدیریت
مشخصات کتاب
Stroke: Pathophysiology, Diagnosis, and Management
ویرایش: [7 ed.] نویسندگان: James C. Grotta MD (editor), Gregory W Albers MD (editor), Joseph P Broderick MD (editor), Scott E Kasner MD MSCE FRCP (editor), Eng H. Lo PhD (editor), Ralph L Sacco MD MS FAHA FAAN (editor), Lawrence KS Wong MD FRCP (editor), Arthur L. Day (editor) سری: ISBN (شابک) : 0323694241, 9780323694247 ناشر: Elsevier سال نشر: 2021 تعداد صفحات: 1176 [1529] زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 83 Mb
قیمت کتاب (تومان) : 35,000
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توجه داشته باشید کتاب سکته مغزی: پاتوفیزیولوژی، تشخیص و مدیریت نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب سکته مغزی: پاتوفیزیولوژی، تشخیص و مدیریت
این متن کلاسیک که توسط برجسته‌ترین متخصصان سکته مغزی در
جهان نوشته شده است، شما را به‌طور کامل با یافته‌های تحقیقاتی و
رویکردهای مدیریتی بیماری‌های عروق مغزی به‌روز می‌کند. سکته
مغزی: پاتوفیزیولوژی، تشخیص و مدیریت، ویرایش هفتم، همه جنبه‌های
این حوزه سریع را پوشش می‌دهد و منبعی ایده‌آل برای متخصصان سکته
مغزی، نورولوژیست‌های عمومی و سایر متخصصان پزشکی با علاقه به
سکته مغزی است. راهنمای بالینی متخصص، پوشش جامع پاتوفیزیولوژی،
داده‌های آزمایش‌های اخیر، پیشرفت‌ها در آزمایش‌های تشخیصی،
تصاویر CT تمام رنگی، اسلایدهای آسیب‌شناسی و بسیاری موارد دیگر
را برای تصویری کامل از پزشکی سکته مغزی امروزی پیدا خواهید
کرد.
- به شما کمک می‌کند تظاهرات بالینی سکته مغزی را بشناسید، از آخرین مطالعات آزمایشگاهی و تصویربرداری برای رسیدن به تشخیص استفاده کنید، و یک برنامه درمانی موثر پزشکی و جراحی ایجاد کنید.
- شما را در جریان حجم عظیم مطالعات و دستورالعمل‌ها در این زمینه پویا قرار می‌دهد و خلاصه‌های واضح و ارزیابی‌های عملی از همه داده‌های مرتبط را ارائه می‌دهد.
- حاوی به‌روزرسانی‌ها، از جمله آخرین آزمایش‌های بالینی (ترومبکتومی، DAWN، DEFUSE)، تحقیقات ژنتیک، تحقیقات پیشگیری، درمان‌های جدید و موارد جدید دستورالعمل های ASA
- شامل اسلایدهای جدیدی برای سخنرانی‌ها است که علوم پایه، مطالعات موردی و مروری بر درمان مداخله‌ای را پوشش می‌دهد.
- در ابتدای هر فصل دارای خلاصه ای از نکات کلیدی است تا بتوانید به سرعت اطلاعات مهم را پیدا کنید.
- تصاویر CT تمام رنگی و اسلایدهای آسیب شناسی فراوانی را ارائه می دهد که به شما در تشخیص کارآمد و دقیق کمک می کند.
- نسخه کتاب الکترونیکی پیشرفته همراه با خرید. کتاب الکترونیکی پیشرفته شما به شما امکان می‌دهد به تمام متن، شکل‌ها و مراجع کتاب در دستگاه‌های مختلف دسترسی داشته باشید.
توضیحاتی درمورد کتاب به خارجی
Authored by the world’s foremost stroke experts, this
classic text brings you fully up to date with current research
findings and management approaches for cerebrovascular disease.
Stroke: Pathophysiology, Diagnosis, and Management, 7th
Edition, covers every aspect of this fast-moving field, and is
an ideal resource for stroke specialists, general neurologists,
and other medical professionals with an interest in stroke.
You’ll find expert clinical guidance, comprehensive
pathophysiology coverage, data from recent trials, advances in
diagnostic tests, full-color CT images, pathology slides, and
much more, for a complete picture of today’s stroke
medicine.
- Helps you 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.
- Keeps you abreast of the overwhelming volume of studies and guidelines in this dynamic field, providing clear summaries and practical evaluations of all relevant data.
- Contains updates throughout, including the latest clinical trials (thrombectomy, DAWN, DEFUSE), genetics research, prevention research, new therapies, and the new guidelines from the ASA.
- Includes new slides for lectures, covering basic science, case studies, and interventional treatment overviews.
- Features a Key Points summary at the beginning of each chapter so you can quickly find important information.
- Provides abundant full-color CT images and pathology slides that help you make efficient and accurate diagnoses.
- Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
فهرست مطالب
Cover Stroke: Pathophysiology, Diagnosis, and Management Copyright Contents Video Contents Foreword to the Seventh Edition Preface Contributors AHA Evidence-Based Classifications SECTION I Pathophysiology 1 - Cerebral Vascular Biology in Health and Disease Introduction Organization of the Cerebral Circulation Physiologic Regulation of Cerebral Vascular Tone Nitric Oxide and Cyclic Guanosine Monophosphate K+ Channels KCa-Activated K+ Channels KATP Channels KV Channels KIR Channels K2P Channels RhoA/Rho-Kinase Reactive Oxygen Species Transient Receptor Potential Channels Alterations in Cerebral Vascular Function During Hypertension and Atherosclerosis Atherosclerosis Cerebral Vascular Oxidative Stress in Models of Atherosclerosis Cerebral Vascular Endothelial Dysfunction in Models of Atherosclerosis Cerebral Vascular Inflammation in Models of Atherosclerosis Hypertension Oxidative Stress in Hypertension Involving Elevated Ang II Endothelial Dysfunction in Hypertension Involving Elevated Ang II Cerebrovascular Inflammation in Hypertension Involving Elevated Ang II K+ Channel Function in Chronic Hypertension BKCa Channels. Basal activity of BKCa channels may be greater in cerebral arteries during chronic hypertension, in that pharmaco... KATP Channels. To our knowledge, there is little information regarding KATP channel function in hypertension. Vasodilator respon... KV Channels. Experimental hypertension may be associated with cerebral artery depolarization and increased myogenic response, pe... KIR Channels. The first evidence for impaired KIR channel function during chronic hypertension was the finding that Ba2+-sensiti... Rho-Kinase in Hypertension Conclusion 2 - Mechanisms of Thrombosis and Thrombolysis Thrombus Formation Fibrinolysis Plasminogen Plasminogen Activation Thrombus Dissolution Plasminogen Activators Endogenous Plasminogen Activators Tissue Plasminogen Activator Urokinase-Type Plasminogen Activator Recent Considerations of Endogenous Thrombolysis That Suggest Approaches to Thrombotic Stroke Exogenous Plasminogen Activators Streptokinase Staphylokinase Plasminogen Activators Derived From Desmodus rotundus Novel Plasminogen Activators Sequential Combinations of Plasminogen Activators in Exogenous Thrombolysis Regulation of Endogenous Fibrinolysis α2-Antiplasmin and α2-Macroglobulin Inhibitors of Plasminogen Activators and Fibrinolysis Clinical Consequences of Therapeutic Plasminogen Activation Limitations to The Clinical use of Fibrinolytic Agents for Ischemic Stroke Plasminogen Activators in Cerebral Tissue Plasminogen Activators and Neuronal Functions Plasminogen Activators and Cerebral Microvessel Integrity Plasminogen Activators in Experimental Cerebral Ischemia Plasminogen Activators and Recanalization in Ischemic Stroke Intervention With Plasminogen Activators Endovascular Interventions Plasminogen Activators and Cerebral Hemorrhage in Ischemic Stroke Conclusion 3 - Cerebral Blood Flow and Metabolism: Regulation and Pathophysiology in Cerebrovascular Disease Normal Cerebral Energy Metabolism Energy Metabolism and Hemodynamics Introduction Cerebral Blood Flow and Other Measurements of Cerebral Perfusion Normal Values of Cerebral Blood Flow and Cerebral Metabolism Control of Cerebral Blood Flow Relationship of Cerebral Blood Flow and Metabolism Response of Cerebral Blood Flow to Changes in Arterial Partial Pressure of Oxygen and Oxygen Content Response of Cerebral Blood Flow to Changes in Blood Glucose Response of Cerebral Blood Flow to Changes in Arterial pCO2 Response of Cerebral Blood Flow to Changes in Blood Viscosity Autoregulation of Cerebral Blood Flow to Changes in Cerebral Perfusion Pressure Response of Cerebral Blood Flow to Multiple Simultaneous Stimuli Hemodynamic Effects of Arterial Stenosis Compensatory Responses to Reduced Cerebral Blood Flow Acute Ischemic Stroke Changes in Cerebral Blood Flow and Metabolism With Acute Ischemic Stroke Flow-Metabolism Thresholds of Tissue Function and Viability in Acute Ischemic Stroke Vasoreactivity and Autoregulation in Ischemic Stroke Remote Flow and Metabolic Effects of Ischemic Stroke Intracerebral Hemorrhage Cerebral Blood Flow and Metabolism Autoregulation Aneurysmal Subarachnoid Hemorrhage Cerebral Blood Flow and Metabolism Autoregulation Conclusions 4 - Histopathology of Brain Tissue Response to Stroke and Injury Four Broad Categories of Cerebral Ischemia Large Vessel Strokes Heart Disease and Cerebral Emboli Carotid Artery Atherosclerosis Infarction Versus Selective Neuronal Necrosis Small Vessel Strokes Hypertensive Arteriolosclerosis White Matter Incomplete Infarction Amyloid Angiopathy Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy Tissue Response to Therapy of Cerebral Ischemia Histopathology of Experimental Stroke Models Histopathology of the Penumbra in Rodent Focal Ischemia Histopathology of CA1 Neuronal Death in Transient Global Ischemia Conclusions 5 - Molecular and Cellular Mechanisms of Ischemia-Induced Neuronal Death Introduction Global Ischemia Focal Ischemia Experimental Models of Global and Focal Ischemia Models of Global Ischemia Models of Focal Ischemia Modalities of Ischemic Cell Death Necrosis Necroptosis Apoptosis Caspase-Dependent Apoptosis Alternative Pathways of Caspase Activation The Bcl-2 Family of Proteins Inhibitors of Apoptosis Caspase-Independent Apoptosis Autophagic Cell Death Ferroptosis Cell Death Patterns and Pathways in Ischemic Stroke Triggers of Ischemic Cell Death Adenosine Triphosphate Deficiency Calcium Glutamate Excitotoxicity N-methyl-d-aspartate Receptors. NMDARs are glutamate-gated ion channels, playing pivotal roles in the regulation of synaptic act... Ca2+-Permeable α-Amino-3-Hydroxy-5-Methyl-4-Isoxazole-Propionic Acid Receptors. AMPARs mediate fast synaptic transmission at exc... Nonexcitotoxic Mechanisms Acid-Sensing Ion Channels. ASICs are abundantly expressed in the neurons throughout the brain, including those in the cerebral c... Transient Receptor Potential Channels. The TRP channel superfamily is a group of weakly voltage-sensitive, largely nonselective ... Zinc Mechanisms and Regulations of Ischemic Neuronal Death Metabolic Stress Mitochondrial Permeabilization Free Radicals and Lipid Peroxidation Nitric Oxide Transcriptional Regulations p53 FOXO-3A REST NF-κB Acknowledgments 6 - Intracellular Signaling: Mediators and Protective Responses Preconditioning Windows of Preconditioning Induction of Preconditioning Cross-Tolerance Cellular Defense Reactive Oxygen Species Mitochondria Neurotrophin Support Survival Kinases Transcription Factors Erythropoietin Inhibition of Cell Death Cellular Maintenance Regeneration and Repair Use of Transcriptomics Human Cell Systems Clinical Implications Future Directions 7 - The Neurovascular Unit and Responses to Ischemia Introduction Architecture of the Central Nervous System and the Neurovascular Unit Structural Relationships: Anatomy of the Cerebral Vasculature Functional Relationships Neuron—Microvessel Communication Neuron—Astrocyte Communication. Neurovascular coupling supports the communication of neurons with astrocytes. However, interacti... Astrocyte—Endothelial Cell (Vascular) Communication. Changes in CBF can be initiated by central neural activation. Specific path... Astrocyte—Smooth Muscle Communication. Pre-capillary arterioles are instrumental in regional CBF regulation, receiving input fro... Microvessel—Neuron Communication Astrocyte—Neuron Communication. In normoxia, astrocytes play dual roles in communication between neurons and the vasculature: en... Endothelial Cell—Astrocyte Communication. Astrocyte end-feet envelope cerebral capillaries and larger microvessels, thus implyin... Evidence for the Neurovascular Unit Interactions Suggesting Unit Communication Structural Changes During Focal Ischemia Microvessel (Endothelial—Astrocyte) Communication Innate Inflammation Glymphatic Clearance Network Propagating Depolarizations and Neurovascular Unit Dysfunction Summary and Implications 8 - Mechanisms of Damage After Cerebral Hemorrhage Experimental Models of Intracerebral Hemorrhage Mechanism of Brain Injury After Intracerebral Hemorrhage Inflammatory Responses After Intracerebral Hemorrhage Oxidative Stress After Intracerebral Hemorrhage Blood Components and Intracerebral Hemorrhage-Induced Injury Red Blood Cell Lysis and Neuronal Toxicity Brain Iron Overload Thrombin Formation Mechanisms of Cell Death After Intracerebral Hemorrhage Apoptosis Excitotoxicity and Cell Death After Intracerebral Hemorrhage Additional Forms of Death After Intracerebral Hemorrhage Blood-Brain Barrier Disruption Modifiers of Intracerebral Hemorrhage-Induced Injury Hypertension Sex Age Therapeutic Approaches Targeting ICH Pathogenesis in Animal Research Surgical Treatment for Intracerebral Hemorrhage Pharmacologic and Other Experimental Treatment for Intracerebral Hemorrhage Conclusion 9 - White Matter Pathophysiology White Matter Anatomy and Physiology Model Systems for Studying White Matter Ischemia Cell Culture In Vitro Tissue Models In Vivo Models Effects of Ischemia on White Matter Derangement of Transmembrane Ion Gradients The Ca2+ Hypothesis and Anoxic-Ischemic White Matter Injury Mechanisms of White Matter Injury Ca2+ Entry and Intracellular Ca2+ Release in Axons During Ischemia Reversal of Na+–Ca2+ Exchange Activation of Voltage-Gated Ca2+ Channels Activation of Intracellular Ca2+ Release Excitotoxic Pathways Injure Glia in White Matter Autoprotection in White Matter Strategies for Protecting White Matter from Anoxic-Ischemic Injury Are Diverse 10 - Inflammation and Immune Response Initiation and Local Propagation of the Immune Response After Stroke Intravascular Events Leading to Inflammation Parenchymal Events Leading to Inflammation Cellular Injury and Damage-Associated Molecular Patterns Release Microglia Response Role of Other Brain Resident Immune Cells, Astrocytes, and Neurons in Inflammation After Stroke The Peripheral Immune Response to Stroke Timeline of the Peripheral Immune Response Gaining Access to the Brain—Entry Points of Peripheral Immune Cells Innate Immune Cells Adaptive Immune Cells Noncoding RNAs and Exosomes as Modulators of the Immune Response The Role of the Immune System in Post-Stroke Brain Repair Phagocytosis Contributing to the Resolution of the Inflammatory Response Mechanisms of Neurovascular Repair: Angiogenesis, Neurogenesis, and Neuroplasticity Immunomodulation and Immune Cell Therapies as a Therapeutic Approach Immune Cell Therapies Targeting Neuroprotection Immunomodulatory Therapeutic Approaches Targeting Tissue Remodeling From Bench to Bedside Conclusions Acknowledgments 11 - Mechanisms of Plasticity Remodeling and Recovery Introduction Endogenous Brain Remodeling After Stroke Angiogenesis Neurogenesis Axonal Remodeling, Oligodendrogenesis, and Synaptogenesis Inflammatory Response Exogenous Therapies for Stroke Cell-Based Therapies Cell Reprogramming for Neurogenesis Bone Marrow MSCs Therapeutic Effects. Bone marrow MSCs are the most-studied adult stem cells and have been widely utilized in th... Exosome Therapies HUCBC-Exosome Therapy MSC-Exosome Therapy Modified-Exosome Therapy Pharmacologic Therapies Conclusion 12 - Genetics and Vascular Biology of Brain Vascular Malformations Brain Arteriovenous Malformations Etiology and Pathogenesis Somatic Mosaicism in Sporadic Arteriovenous Malformations Arteriovenous Malformation Pathobiology Genetic Considerations Relevant to Arteriovenous Malformations Mendelian Disease Familial Aggregation Genetic Studies of Non-familial Arteriovenous Malformation Candidate Gene and Genome-Wide Studies Insights From Experimental Arteriovenous Malformation Models Summary and Synthesis of Arteriovenous Malformation Etiology and Pathogenesis Cerebral Cavernous Malformations Overview Cerebral Cavernous Malformation Genetics CCM1/KRIT1 CCM2/MGC4607 CCM3/PDCD10 Cerebral Cavernous Malformation Pathogenesis and Biology Genotype-Phenotype Correlation Summary of Cerebral Cavernous Malformation Biology and Pathogenesis Other Vascular Malformations Summary of Other Vascular Malformations Acknowledgments 13 - Gliovascular Mechanisms and White Matter Injury in Vascular Cognitive Impairment and Dementia Introduction The Neurovascular Unit in Vascular Cognitive Impairment and Dementia Experimental Models for Vascular Cognitive Impairment and Dementia Spontaneously Hypertensive Stroke Prone Rat Rat Bilateral Common Carotid Artery Occlusion Mouse Bilateral Common Carotid Artery Stenosis Rat and Mouse Two-Vessel Gradual Occlusion Focal Injection of Vasoconstrictors Transgenic CADASIL Mice Middle Cerebral Artery Occlusion Astrocyte and Extracellular Matrix Dysfunction Oligodendrocyte Lineage Cells Oligodendrocyte-Endothelium Interactions Oligodendrocyte-Astrocyte Interactions Oligodendrocyte-Microglia Interactions The Gliome and the Vasculome Conclusions and Future Opportunities SECTION II Epidemiology and Risk Factors 14 - Global Burden of Stroke Introduction GBD Methods Overall Stroke Estimates Ischemic Stroke Hemorrhagic Stroke Sex Differences Interpretations of GBD Stroke Trends 15 - Stroke Disparities Introduction Racial and Ethnic Disparities in Stroke Sex Disparities in Stroke Geographic Disparities in Stroke Urban-Rural Disparities in Stroke Regional Differences in Stroke Socioeconomic Status and Stroke Conclusions 16 - Risk Factors and Prevention Epidemiology and Risk Factors Magnitude of the Problem Mortality Cost Incidence of Stroke Frequency of Stroke by Type Silent Stroke Recurrent Stroke Vascular Bruits Risk Factors for Stroke Atherogenic Risk Factors Hypertension Hypertension and the Risk of Stroke. About 77% of people who have a first stroke, about 69% who have a first heart attack, and a... Isolated Systolic Hypertension. Isolated systolic hypertension (≥160/<90 mm Hg) becomes increasingly prevalent in the elderly, a... Long-Term Blood Pressure and Risk of Stroke. Blood pressure-related stroke risk predictions are generally based on the measureme... Blood Lipids Diabetes and Glucose Intolerance Obesity Sleep-Disordered Breathing Family History of Stroke Fibrinogen, Clotting Factors, and Inflammation Inflammation Blood Homocysteine Levels Heart Disease and Impaired Cardiac Function Coronary Heart Disease Atrial Fibrillation Clinical Heart Failure Left Ventricular Hypertrophy Peripheral Artery Disease Migraine Environmental Factors Tobacco Use Air Pollution Oral Contraceptives Hormone Replacement Therapy Alcohol and Illicit Drug Use Physical Activity Diet Identification of High-Risk Candidates for Stroke Prevention. Multivariable risk prediction models are used with the understandi... Preventing a First Stroke Primordial Prevention Lifestyle Modification Cigarette Smoking Physical Activity Weight Management and Diet Alcohol and Illicit Drug Use Management of Modifiable Risk Factors to Prevent First Stroke Hypertension. Hypertension is one of the most important modifiable risk factors for prevention of a first stroke.141 AHA Guideli... Diabetes. Although generally considered a disease having pathophysiologic effects related to impaired blood glucose control, the... Atrial Fibrillation. Nonvalvular AF is an important, treatable risk factor for stroke. Depending on patient age, the population ... Sleep-Disordered Breathing. There are no prospective trials showing that treatment of sleep apnea reduces stroke risk. AHA Prima... Lipid-Lowering Therapy. Unlike coronary heart disease, there is only a weak relationship between lipid levels and stroke risk;23... 17 - Prognosis After Stroke Introduction Mortality After Ischemic Stroke Early Mortality After Ischemic Stroke Late Mortality After Ischemic Stroke Predictors of Death After Ischemic Stroke Age, Sex, and Race-Ethnicity Initial Stroke Severity Ischemic Stroke Subtypes Blood Pressure, Atrial Fibrillation, and Heart Failure Hyperglycemia and Diabetes Pyrexia and Fever Inflammatory Markers and Other Biochemical Blood Parameters Reccurence After Ischemic Stroke Predictors of Recurrence After Ischemic Stroke Ischemic Stroke Subtypes and Stroke Recurrence Early Hospital Readmissions and Recurrent Stroke Stroke Outcome Prediction Models Functional Disability and Handicap After Stroke Quality of Life After Stroke Depression After Stroke 18 - Vascular Dementia and Cognitive Impairment Historical Evolution of the Concept of Vascular Dementia Diagnostic Criteria for Vascular Dementia Cognitive Impairment and Dementia Following Stroke Expanded Concept of Vascular Cognitive Impairment Overlap of Vascular and Neurodegenerative Pathologies Epidemiology Clinical Diagnosis Vascular Mild Cognitive Impairment Neuropsychological Assessments of Vascular Cognitive Impairment Imaging Correlates of Vascular Cognitive Impairment (fig. 18.2) Prevalence of Cerebrovascular Brain Injury Association of Cerebrovascular Brain Injury With Cognitive Changes Summary Neuropathologic Aspects Other Vascular Pathologies Prevention of Vascular Cognitive Impairment Association of Vascular Risk Factors With Vascular Cognitive Impairment and Vascular Dementia Genetic Factors Modifiable Risk Factors Lifestyle Factors Association of Vascular Disease Severity Measures With Vascular Cognitive Impairment Association of Common Clinical Disease States With Vascular Cognitive Impairment Coronary Artery Disease Chronic Kidney Disease Atrial Fibrillation Peripheral Arterial Disease Heart Failure and Cardiac Output Depression Thrombosis and Antiplatelets Treatment of Persons With Clinical Vascular Dementia Control of Vascular Risk Factors Pharmacologic Treatment of Cognitive Impairment Summary 19 - Genetic Basis of Stroke Occurrence, Prevention, and Outcome Introduction Evidence for Heritability of Stroke and its Subtypes Disorders Associated with Ischemic or Hemorrhagic Stroke Fabry Disease CADASIL CARASIL Homocystinuria Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes Sickle Cell Anemia Fibromuscular Dysplasia Vascular Ehlers-Danlos Syndrome Collagen Type IV Alpha 1 Mutations Hypercoagulable Disorders Moyamoya Disease Mendelian Cerebral Amyloid Angiopathy Mendelian Cerebral Cavernous Malformation Syndromes Autosomal Dominant Polycystic Kidney Disease Hereditary Hemorrhagic Telangiectasia Retinal Vasculopathy With Cerebral Leukodystrophy Cathepsin A-related Arteriopathy With Strokes and Leukoencephalopathy Non-Mendelian Risk Factors Ischemic Stroke Intracerebral Hemorrhage Intracranial Aneurysms Evidence for a Genetic Component in Intracranial Aneurysms Candidate Gene Association Studies Genome-Wide Association Studies Summary and Future Directions SECTION III Clinical Manifestations 20 - Classification of Ischemic Stroke History Challenges in the Diagnosis of Etiologic Subtypes Probabilistic Approach to Etiologic Stroke Classification Phenotypic Versus Causative Classification Unstable Causative Etiology Large Artery Atherosclerosis Infarct Mechanism Perfusion Failure Artery-to-Artery Embolism Clinical Features Results of Diagnostic Tests Brain Imaging Vascular Imaging Embolism Attributed to Cardiac Sources Properties of Emboli Clinical Features Results of Diagnostic Tests Small Artery Occlusion Clinical Features Results of Diagnostic Tests Uncommon Causes of Stroke Stroke of Undetermined Etiology 21 - Clinical Scales to Assess Patients With Stroke Desired Qualities of Stroke Scales Scales Used by Emergency Medical Services Scales to Differentiate Hemorrhagic Stroke From Ischemic Stroke Differentiation of Ischemic Stroke Syndromes Scales to Quantify the Severity of Intracerebral Hemorrhage Scales to Quantify the Severity of Subarachnoid Hemorrhage Scales to Quantify the Severity of Ischemic Stroke Systems to Forecast the Risk of Stroke Among Patients with Transient Ischemic Attack Risk Stratification Assessment of Transient Ischemic Attack Scales Used to Assess Patients with Atrial Fibrillation Systems to Differentiate the Cause of Ischemic Stroke (Stroke Subtype) Scales and Measures to Assess Responses to Rehabilitation Interventions Scales to Rate Outcomes (Disability) After Stroke Scales to Rate Outcomes (Global or Handicap) After Stroke Scales to Assess the Quality of Life After Stroke 22 - Carotid Artery Disease Epidemiology Carotid Anatomy and Lesion Development Lesion Location Tempo of Development of Carotid Stenosis Pathophysiology of Atherosclerosis Evaluation of Extracranial Carotid Stenosis Auscultation Degree of Stenosis Plaque Surface Irregularity and Ulceration Plaque Composition and Inflammation Cerebrovascular Reserve Microembolization Intracranial Carotid Artery Disease Carotid Disease Other Than Atherosclerosis Spontaneous Dissection Fibromuscular Dysplasia Primary Tumors of the Vascular Structures Complications of Head and Neck Cancer Radiotherapy Restenosis After Prior Carotid Revascularization Pathophysiology of Carotid Artery Ischemia Collateral Pathways Intracranial Pathways Borderzone Collaterals. Flow retrograde from cerebral arteries through the borderzones over the brain surface may spare some or ... Mechanisms of Ischemic Stroke and Transient Ischemic Attack Clinical Syndromes From Carotid Artery Disease Ocular Infarction Ischemic Optic Neuropathy and Ischemic Retinopathy Anterior Choroidal Artery Syndromes Cerebral Infarction Dementia and Cognitive Impairment Transient Ischemic Attacks Transient Monocular Blindness Hemisphere Transient Ischemic Attacks Stroke Risk in Patients With Carotid Disease Symptomatic Carotid Stenosis Asymptomatic Carotid Stenosis Carotid Artery Occlusion Intracranial Stenosis 23 - Anterior Cerebral Artery Disease Anatomy Anomalies and Species Differences Symptoms and Signs Weakness and Sensory Loss Callosal Disconnection Signs Akinetic Mutism (Abulia) Language Disturbance Other Mental Abnormalities Incontinence and Other Autonomic Changes Miscellaneous Symptoms Periventricular Leukomalacia of Infancy 24 - Middle Cerebral Artery Disease Descriptive Terms Names of Stem, Divisions, and Branches Other Anatomic Features Arterial Segments in Relation to Anatomic Landmarks Anomalies Borderzone Anastomoses Histology Pathology Embolism Etiology Particle Size and Composition Distribution in the Middle Cerebral Artery Territory Persistence of Material Effects of Collateral Flow on Embolic Infarct Patterns Clinical Syndromes of Embolism Thrombosis Atherosclerosis Stenosis Dissection Capsular Warning Syndrome Other Diseases CLINICAL SYNDROMES OF MIDDLE CEREBRAL ARTERY TERRITORY INFARCTION Clinical Syndromes From Infarction of Either Hemisphere Loss of Consciousness Hemiplegia and Hemiparesis Hemiplegia Syndromes of Partial Hemiparesis Monoplegia Recovery From Hemiparesis Infarcts Without Hemiparesis Movement Disorders Contraversive Eye and Head Deviation Types of Head and Eye Deviation Eye Deviation and Infarct Topography Duration of the Deviation and Severity of Infarct Infarction With No Eye Movement Disturbances Dizziness and Vertigo Sensory Disturbances Hemispherectomies and Sensory Disturbances Pure Sensory Deficits Hemisensory Deficits and Lesion Topography Correlation of Sensory Disturbances With Motor Deficits Visual Field Disturbances Quadrantanopia Impairment of Opticokinetic Nystagmus Autonomic Disturbances Aphasia Global or Total Aphasia Clinical Features. Occlusion of the MCA trunk or its upper division produces a global disruption of language function. The initi... Lesion Size. With the advent of CT and MRI, a volumetric measure of the lesion permits estimation of the lesion size associated ... Motor Aphasia Major Motor Aphasia. In its usual form, major motor aphasia appears to be an improvement of a syndrome of total aphasia and is a... Minor Motor Aphasia. Focal infarcts affecting the operculum produce a rather circumscribed syndrome lacking the full elements of... Speech Disturbances With Lower Rolandic Infarction. Few cases of lower rolandic infarction have been reported since the days of ... Speech Disturbances From Deep Infarcts. Infarcts affecting the motor outflow of both sides have produced mutism as part of a syn... Sensory Aphasia Major Sensory Aphasia. An occlusion that blocks the trunk or branches of the lower division of MCA causes a large infarct encomp... Minor Sensory Aphasia and Variants. Retrograde collateral flow established from the branches of the posterior cerebral artery ma... Pure Word Deafness. More than 40 cases with CT or autopsy correlation of pure word deafness have been reported. According to the... Cortical Deafness. At least one case report exists of an autopsied patient who was well studied clinically and was found to have... Alexia With Agraphia. Alexia with agraphia as an isolated syndrome, with absent aphasic errors in speech or in auditory comprehe... Conduction Aphasia “Transcortical” Aphasia Functional Imaging in Aphasia Epidemiology and Natural History of Aphasia Efficacy of Aphasia Therapy Innovative Aphasia Therapies Apraxias Ideomotor Apraxia Ideational Apraxia Limb-Kinetic Apraxia Callosal Apraxia Oral-Buccolingual Apraxia Syndromes of Infarction in the Hemisphere Nondominant for Speech and Language Neglect and Extinction Neglect From Frontal Lesion Motor Neglect Neglect for Verbal Material Anosognosia Impersistence Dressing Apraxia Loss of Topographic Memory and Disorientation for Place Disorders of Spatial Localization Confusion and Delirium Confabulation and Reduplicative Paramnesia Constructional Apraxia Allesthesia Amusia Aprosody and Affective Agnosia Treatment of Hemineglect 25 - Posterior Cerebral Artery Disease Anatomy Pathology and Stroke Mechanisms Large-Artery Disease Artery-to-Artery Embolism Branch Occlusion In Situ Thrombotic Occlusion Hemodynamic Disturbance Small (Penetrating)-Artery Disease Cardiac Embolism Uncommon Causes Dissection Migraine Moyamoya Disease Fibromuscular Dysplasia Reversible Cerebral Vasoconstriction Syndrome Arterial Compression Mitochondrial Disease Other Miscellaneous Causes Prevalence and Frequency of Involved Structures Clinical-Topographic Correlation Midbrain Infarction Thalamic Infarction Inferolateral (Thalamogeniculate) Artery Territory Infarction Tuberothalamic (Polar) Artery Territory Infarction Paramedian (Thalamic-Subthalamic) Artery Territory Infarction Posterior Choroidal Artery Territory Infarction Combined Polar and Paramedian Territory Infarction Cortical (Superficial) Infarction Visual Field Defects Palinopsia. Palinopsia is the visual perseveration of images over time—that is, a recent image either persists after the object ... Other Visual Perception Disorders. Other visual perception disorders caused by occipital infarction include cerebral polyopia (m... Visual Agnosia. Visual agnosia is the inability to recognize visually presented objects despite the preservation of elementary s... Prosopagnosia. Prosopagnosia is the inability to recognize previously familiar faces.158 The deficit is mostly restricted to the... Topographic Disorientation (Topographagnosia). Patients with topographic disorientation are unable to find their way around thei... Alexia. Reading difficulties (alexia or dyslexia) occur to varying degrees in the majority of patients with dominant (mostly lef... Achromatopsia. Achromatopsia is the inability to perceive color following brain injury.203 The total absence of color perception... Memory Impairment. Bilateral or unilateral left PCA infarction produces significant memory impairment by damaging the hippocampu... Emotional and Behavioral Disturbances. Patients with bilateral (or less often unilateral) PCA infarction occasionally show restl... Bilateral Infarction and Associated Syndromes Transient Ischemic Attack Sensory Transient Ischemic Attack Visual Transient Ischemic Attack Prognosis General Prognosis Sequelae Involuntary Movements Visual Field Defect 26 - Vertebrobasilar Disease Anatomy Vertebral Artery Cerebellar Arteries Posterior Inferior Cerebellar Artery Anterior Inferior Cerebellar Artery Superior Cerebellar Artery Basilar Artery and Its Main Branches Persistent Anastomotic Links Pathology and Stroke Mechanisms Large Artery Disease Mechanisms of Stroke in Large Artery Disease Artery-to-Artery Embolism. Atherosclerotic plaques with erosion and ulceration often generate embolism.28,29 Emboli arising from... In Situ Thrombotic Occlusion. In patients with intracranial artery atherosclerosis, thrombus formation in areas of plaque can re... Branch Occlusion. Atherosclerotic plaques in an intracranial artery can occlude the orifice of one or several perforators, causi... Hypoperfusion. In patients with severe vascular stenosis/occlusion and insufficient collaterals, hemodynamic transient ischemic ... Intracranial Vertebral Artery. Generally, ICVA occlusive disease is a more serious condition than ECVA disease. Unilateral ICVA ... Basilar Artery. Pathologically56 and angiographically57 documented BA occlusion often leads to catastrophic bilateral pontine in... Small Artery (Penetrating Artery) Disease Cardiac Embolism Less Common Causes Dissection Fusiform (Dolichoectatic) Dilatation Arterial Compression Fibromuscular Dysplasia Moyamoya Disease. Moyamoya disease is characterized by progressive occlusion of the distal ICA or proximal MCA, with the develop... Giant Cell (Temporal) Arteritis. Giant cell arteritis is a systemic vasculitis characterized by subacute granulomatous inflammat... Infectious or Immunologic Vasculitis. Vasculitis may be caused by infectious (e.g., bacterial, tuberculous, spirochetal, fungal,... Persistent Anastomotic Links. A persistent trigeminal artery (PTA) is the most common embryonic carotid-basilar anastomosis, occ... Vascular Topographic Syndromes Medullary Infarction Lateral Medullary Infarction Clinical Manifestations Dizziness, Vertigo, and Ataxia. A dizzy sensation and gait instability are the most common symptoms occurring in more than 90% o... Nystagmus and Ocular Motor Abnormality. Involvement of the vestibular nuclei and their connections lead to nystagmus. The nystag... Nausea/Vomiting. Nausea/vomiting is usually an initial and transient symptom closely associated with vertigo, nystagmus, and gai... Horner Syndrome. Elements of Horner syndrome are frequent, occurring in about 90% of patients. This is caused by involvement of ... Dysphagia, Dysarthria, Hoarseness. Involvement of the nucleus ambiguus results in paralysis of the ipsilateral palate, pharynx, ... Hiccup. Approximately one-fourth of patients develop hiccup,31,158 often days after stroke onset. Hiccup usually goes away withi... Sensory Symptoms/Signs. Sensory symptoms/signs are one of the most common manifestations of LMI. In the largest series, sensory ... Headache. Headache occurs in about half of the patients.31,158 It usually begins at onset or a few days before other symptoms/si... Facial Palsy. Facial palsy, usually mild and upper neuron type, is present in one-fifth to one-fourth of patients.31 It is presu... Respiratory Difficulty and Other Autonomic Signs. The medullary reticular formation contains neurons related to the control of r... Ipsilateral Hemiparesis. Ipsilateral hemiparesis may be associated with other typical symptoms of LMI.172 Clinical-Topographic Correlation Stroke Mechanisms Prognosis Medial Medullary Infarction Clinical Manifestations Limb Weakness. Contralateral hemiparesis sparing the face is the most characteristic sign of MMI.191 Quadriparesis occurs in les... Facial Palsy. Although sparing of the face is one of the characteristics of MMI, mild and transient facial paresis occurs in one... Dysarthria, Dysphagia. In patients with quadriparesis, dysarthria and dysphagia are severe whereas a nasogastric tube is require... Ipsilateral Hypoglossal Nerve Palsy. Ipsilateral hypoglossal nerve palsy was one of the Dejerine symptom triad and has been cons... Sensory Dysfunction. Sensory dysfunction is the second most important symptom/sign of MMI. Unlike LMI patients, MMI patients typ... Ataxia. Limb incoordination is occasionally noted42,186 and is usually attributed to involvement of pontocerebellar fibers and/o... Vertigo/Dizziness, Nystagmus, and Ocular Motor Disturbances. These symptoms/signs are closely related to involvement of the dors... Emotional Disturbances. Previous reports have described patients presenting with pathologic crying and laughing, depression, and... Clinical-Topographic Correlation Bilateral Medial Medullary Infarction Stroke Mechanism Prognosis Combined Lateral Medullary Infarction and Medial Medullary Infarction Pontine Infarcts Clinical Features Motor Dysfunction (Including Dysarthria and Ataxia) Sensory Dysfunction Ocular Motor Dysfunction Sixth Nerve Palsy. The abducens nucleus is located in the paramedian, dorsal, lower pons. Although rare, isolated 6th nerve pals... Internuclear Ophthalmoplegia. Internuclear ophthalmoplegia (INO) due to involvement of the MLF is much more common in patients w... Conjugate Horizontal Gaze Palsy. Fibers from the frontal eye fields affecting conjugate lateral gaze cross at or near the level ... One-and-a-Half Syndrome. Fisher236 introduced the term one-and-a-half syndrome to refer to “a paralysis of eye movements in whic... Ocular Bobbing and Other Related Signs. Fisher238 introduced the term ocular bobbing: “The eyeballs intermittently dip briskly ... Periodic Limb Movements and Restless Leg. Periodic limb movements or restless legs are involuntary movements associated with sle... Other Cranial Nerve Dysfunction Auditory Symptoms Consciousness Disturbances or Coma Abnormalities of Respiration Emotional Disturbances Clinical-Topographic Correlation Unilateral Infarcts Unilateral Paramedian Basal Infarcts Unilateral Paramedian Tegmental Combined Basal-tegmental Infarction Unilateral Circumferential Artery Territory (Ventrolateral) Infarcts Unilateral Dorsolateral Infarcts Bilateral Infarcts Stroke Mechanisms Prognosis Midbrain Infarction Clinical Features Ocular Motor Dysfunction Third Nerve Palsy. Third nerve palsy occurs in 33%–50%40,266,268 of patients with pure midbrain infarction due to involvement of... Internuclear Ophthalmoplegia. The lesions producing an INO are located in the paramedian, dorsal lower midbrain, involving the M... Vertical Gaze Disturbances. Involvement of the most rostral part of the midbrain produces vertical gaze paresis (see “Top of the... Fourth Nerve Palsy. The trochlear nucleus lies in the lower midbrain caudal to the oculomotor nuclear complex. Unlike 3rd nerve ... Hemiparesis and Other Motor Dysfunction Sensory Symptoms/Signs Ataxia Parkinsonism. Midbrain strokes may produce hemi-parkinsonism due to involvement of the substantia nigra.281–283 The prevalence i... Dystonia. Unilateral dystonia may be observed in patients with extensive ponto-mesencephalic tegmental lesions,286 usually assoc... Asterixis. Paramedian midbrain infarcts may produce asterixis in the contralateral limbs,287 probably related to the involvement... Neuropsychiatric and Emotional Disturbances Clinical-topographic Correlation Anteromedial (or Paramedian) Lesion Anterolateral Lesion Combined Lesions Lateral Lesion Dorsolateral Lesion Bilateral Lesions Stroke Mechanism Prognosis Cerebellar Infarcts Clinical Manifestations Classic Cerebellar Syndromes Cognitive Dysfunction Emotional Disturbances Clinical-topographic Correlation Posterior Inferior Cerebellar Artery Infarction Stroke Mechanisms Prognosis Superior Cerebellar Artery Territory Infarction Stroke Mechanism Prognosis Anterior Inferior Cerebellar Artery Infarction Stroke Mechanism Prognosis Top of the Basilar Artery Syndrome Clinical Features Somnolence and Loss of Attention Hallucinations Confabulations Hemiballism and Abnormal Movements Other Symptoms and Signs Stroke Mechanisms and Prognosis 27 - Lacunar Syndromes, Lacunar Infarcts, and Cerebral Small-Vessel Disease Historical Aspects The Spectrum Of Cerebral Small-Vessel Disease Definitions Pathoanatomy Risk Factors Imaging Studies Computed Tomography Magnetic Resonance Imaging Clinical Syndromes Pure Motor Stroke Clinicoanatomic Correlations Other Causes of Pure Motor Syndromes Clinical Features Clinical Course Pure Sensory Stroke Nature of the Sensory Complaints Clinical Course Sensorimotor Stroke Ataxic Hemiparesis Dysarthria-Clumsy Hand Syndrome Other Stroke Syndromes Associated With Lacunar Infarcts Speech and Language Disorders and Other Disorders of Higher Cerebral Function Specificity of the Clinical Lacunar Syndromes for Small-Vessel Disease. Several early studies tested the diagnostic validity of ... Prognosis Aspects on Therapy in Lacunar Infarcts Thrombolysis in Acute Ischemic Stroke The Capsular Warning Syndrome Dilemma Statin Therapy. Current guidelines recommend statin therapy in patients with ischemic stroke with few exclusion criteria (see se... Blood Pressure Lowering. Two target levels of blood pressure were tested in the SPS3 trial: “higher” 130–149 mm Hg versus “lower... Concurrent Potential Causes of Ischemic Stroke 28 - Intracerebral Hemorrhage Introduction Etiology and Risk Factors Diagnostics and Prognosis Brain Imaging Computed Tomography Angiography Spot Sign Prognostic Scales Organization of Care Medical Management Blood Pressure Control Antiplatelet Therapy Related Intracerebral Hemorrhage Anticoagulation-Related Intracerebral Hemorrhage Hemostatic Strategies Complications Seizures Cerebral Edema Prevention of Venous Thromboembolism Neurosurgery Craniectomy for Evacuation of the Cerebellar/Brainstem Intracerebral Hemorrhage Craniectomy for Evacuation of the Supratentorial Intracerebral Hemorrhage External Ventricular Drainage Secondary Prevention Conclusions 29 - Aneurysmal Subarachnoid Hemorrhage Historical Aspects Epidemiology Risk Factors Causes of Subarachnoid Hemorrhage Pathophysiology Distribution and Types of Aneurysms Aneurysm Development Aneurysm Rupture Clinical Presentation Signs and Symptoms Misdiagnosis of Subarachnoid Hemorrhage Radiographic and Diagnostic Testing Searching for the Aneurysm Cerebral (Catheter) Angiography Computed Tomography Angiography Magnetic Resonance Angiography Angiographically “Negative” Subarachnoid Hemorrhage Grading Scales for Subarachnoid Hemorrhage Management General Measures Blood Pressure Management Fluid Management Temperature Control Avoiding Hyperglycemia Nutrition Neuroprotective Agents Nimodipine and Other Calcium Antagonists. A 2007 Cochrane Database Systematic Review evaluated 16 randomized trials of calcium a... Steroids. There is no evidence to support the routine use of steroids in patients with aneurysmal SAH. A 2005 Cochrane Database ... Magnesium. Traditionally, IV magnesium was thought to have favorable effects on the arterial vasculature and vasospasm and that ... Statins. There has been interest in statins as possible neuroprotective agents in SAH. The physiologic rationale for using stati... Antiplatelets. DCI with subsequent infarction after aneurysmal SAH is a major source of long-term disability. Although the mecha... Venous Thromboembolism Prophylaxis Stress Ulcer Prophylaxis Ventilator Management Sedation and Analgesia Securing the Aneurysm: Surgical Versus Endovascular Treatment Neurologic Complications Aneurysmal Rebleeding Hydrocephalus Seizures Vasospasm, Delayed Cerebral Ischemia, and Infarction Cerebral Edema Medical Complications of Subarachnoid Hemorrhage Cardiac Complications Pulmonary Complications Infection Endocrine Disturbances Electrolyte Abnormalities Summary of Management of Patients With Subarachnoid Hemorrhage Harmonization of Clinical Variables Outcomes 30 - Arteriovenous Malformations and Other Vascular Anomalies Introduction Anomalies of the Arterial Wall Aneurysms Telangiectasias Moyamoya Anomalies of the Capillary Junction Brain Arteriovenous Malformations History and Pathogenetic Concepts Epidemiology Diagnosis and Risk Evaluation Treatment Strategy Dural Arteriovenous Fistulae Anomalies of Cerebral Veins Cavernous Malformations Diagnosis and Risk Stratification Treatment Strategy Developmental Venous Anomaly 31 - Stroke and Other Vascular Syndromes of the Spinal Cord Introduction Historical Aspects Anatomy: Blood Supply to the Spinal Cord Longitudinal Arteries Radicular Tributary Arteries Intrinsic (Feeder) Arteries Venous System Physiology of Spinal Cord Blood Flow Pathology of Spinal Cord Infarction Etiology Spontaneous Spinal Cord Ischemia Diseases of the Aorta Systemic Hypoperfusion Iatrogenic Ischemia of the Spinal Cord Clinical Presentation of Spinal Cord Infarction Anterior Spinal Artery Syndrome Posterior Spinal Artery Syndrome Venous Infarction Differential Diagnosis Diagnostic Testing Treatment Prognosis SECTION IV Specific Conditions and Stroke 32 - Cardiac Diseases Clinical Features of Cardioembolic Transient Ischemic Attack or Stroke Diagnostic Studies Approach to Management Specific Cardiac Conditions Causing Cerebral Embolism Structural Cardiac Defects Cardiomyopathy Acute Myocardial Infarction Patent Foramen Ovale Intracardiac Tumors Spontaneous Echo Contrast Valvular Strands Dysrhythmias Atrial Fibrillation Sick Sinus Syndrome Atrial Flutter Valvular Disease Rheumatic Mitral Valve Disease Mitral Annular Calcification Prosthetic Valves Mitral Stenosis Infective Endocarditis Nonbacterial Thrombotic Endocarditis Other Valvular Disorders Cardiac Procedures Coronary Artery Bypass Surgery-Related Embolism Cardiac Catheterization Cardiac Embolism and the Hemostatic System Atrial Cardiopathy and Risk of Stroke 33 - Atherosclerotic Disease of the Proximal Aorta Frequency of Aortic Plaques in the General Population Aortic Plaques and Ischemic Stroke—Pathology Studies In Vivo Studies—Transesophageal Echocardiography Case-Control Studies Prospective Studies Plaque Morphology and Stroke Risk Natural History of Aortic Plaques Aortic Plaques in Stroke Patients of Different Race-Ethnicity Factors Associated With Aortic Plaques in Stroke Patients Proximal Aortic Plaques and Transient Ischemic Attack Aortic Plaques and Subclinical Cerebrovascular Disease Proximal Aortic Plaques and Atrial Fibrillation Proximal Aortic Plaques and Carotid Artery Disease Proximal Aortic Plaques and Coronary Artery Disease Aortic Plaques and Atheroembolism Proximal Aortic Plaques and Cardiac Surgery Proximal Aortic Plaques and Cardiac Catheterization Proximal Aortic Plaques and Transcatheter Aortic Valve Replacement Atherosclerosis of Aortic Arch Branch Vessels and Ischemic Stroke Risk Treatment of Proximal Aortic Plaques Systemic Anticoagulation Antiplatelet Medications Thrombolysis Statins Surgery Proximal Aortic Plaques and Ischemic Stroke—Future Directions Plaque Morphology—Newer Imaging Modalities Identification of the Vulnerable (High-Risk) Plaque Summary 34 - Stroke Related to Surgery and Other Procedures Introduction Perioperative Risk Assessment Carotid Assessment Prior to Cardiac and Other Surgery Periprocedural Antithrombotic Management in Patients With Cerebrovascular Disease Acute Stroke Therapy Conclusion 35 - Arterial Dissection, Fibromuscular Dysplasia, and Carotid Webs Arterial Dissections Epidemiology Pathology Pathogenesis Sites of Dissection Mechanisms of Ischemia Clinical Manifestations Intracranial Carotid and Middle Cerebral Artery Dissection Extracranial Vertebral Artery Dissection Local Signs and Symptoms. Headache occurs in one-half to two-thirds of patients with extracranial vertebral dissection and is ty... Ischemic Signs and Symptoms. The majority of patients with vertebral artery dissection have ischemic symptoms, although this may... Intracranial Vertebral and Basilar Artery Dissections Diagnosis Ultrasonography Magnetic Resonance Imaging Computed Tomography Angiography Treatment Medical Therapy Neuroendovascular Interventional Therapy Surgical Therapy Course and Prognosis Fibromuscular Dysplasia Epidemiology Pathology Pathogenesis Sites Clinical Manifestations and Diagnosis Treatment Carotid Webs Epidemiology Pathology, Pathogenesis, and Mechanism of Ischemia Diagnosis Treatment 36 - Inflammatory and Infectious Vasculopathies Vasculitides of the Central Nervous System Primary Vasculitis of the Central Nervous System Secondary Vasculitis of the Central Nervous System Medium- to Small-Vessel Vasculitides Polyarteritis Nodosa. PAN is a necrotizing angiitis of the medium to small muscular arteries throughout the body. The peripheral... Granulomatosis With Polyangiitis (Formerly Wegener Granulomatosis). Wegener granulomatosis is an ANCA-associated necrotizing gra... Eosinophilic Granulomatosis With Polyangiitis (Formerly Churg-Strauss Syndrome). Eosinophilic granulomatosis with polyangiitis (... Cryoglobulinemia. Cryoglobulinemia may be associated with systemic vasculitis.90 CV is a small-vessel systemic vasculitis result... Behçet Disease. Vasculitis occurring in patients with BD can affect arteries or veins. According to the Chapel Hill Consensus Cl... Systemic Lupus Erythematosus. Reports on the neurologic manifestations of SLE have long emphasized the relatively high frequency... Rheumatoid Arthritis. CNS manifestations of rheumatoid arthritis (RA) are rare and tend to occur in the setting of long-establis... Infectious Diseases and Stroke Bacterial/Spirochetal Infections Treponema Pallidum Mycobacterium Tuberculosis Parasitic Infections Chagas Disease Neurocysticercosis Fungal Infections Cryptococcal Meningitis Aspergillosis Mucormycosis Viral Infections Human Immunodeficiency Virus Herpesviruses Cytomegalovirus. CMV has been recognized as a contributor to vasculopathy after heart transplantation.267 Elevated titers agains... Varicella Zoster Virus. Arterial infection by VZV is a well-known but underdiagnosed cause of arteriopathy and vascular events, ... Parvovirus B19. Parvovirus B19 is a common virus that is capable of infecting erythrocytes and endothelial cells. In an internat... Coronavirus Disease 2019 (COVID-19). In late 2019, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initiated a ... 37 - Reversible Cerebral Vasoconstriction Syndromes Introduction History, Evolution, and Associated Conditions Demographics and Clinical Features Laboratory Findings Brain Imaging Vascular Imaging Differential Diagnosis Etiology and Pathophysiology Management OUTCOME AND PROGNOSIS 38 - Posterior Reversible Encephalopathy Syndrome Definition and Clinical Features Historical Recognition of Posterior Reversible Encephalopathy Syndrome Epidemiology and Associated Clinical Conditions Associated With Abrupt Hypertension/Cerebral Hyperperfusion Eclampsia Medications Toxicities Thrombotic Microangiopathy Syndromes Sepsis Clinical Features, Exam and Laboratory Findings Imaging Findings Pathophysiology Treatment Sequelae 39 - Stroke and Substance Abuse Opioids Amphetamine and Related Agents Other Related Psychostimulants Cocaine Phencyclidine Lysergic Acid Diethylamide Marijuana Barbiturates Inhalants Alcohol Tobacco 40 - Moyamoya Disease Guideline for Diagnosis Epidemiology Pathology The Circle of Willis and the Major Branches Perforating Arteries (Moyamoya Vessels) Leptomeningeal Vessels Aneurysm Formation Extracranial Cervical Arteries and Systemic Arteries Etiology and Pathogenesis Clinical Symptoms and Signs Laboratory Findings Clinical Examination Angiography Computed Tomography Magnetic Resonance Imaging and Angiography Ultrasonography Electroencephalography Other Clinical Examinations Disease Progression and Prognosis Treatment Medical Treatment Surgical Treatment Conclusion and Future Directions 41 - Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy History Clinical Presentation Neuroimaging Pathology Genetics Diagnosis Conclusion 42 - Hematologic Disorders and Stroke Introduction Pathogenesis of Thrombosis Vascular Injury Hereditary Deficiencies Combined Genetic Prothrombotic Factors and Association With Patent Foramen Ovale. In a cohort of young (aged 55 or younger) pati... Acquired Deficiencies Association With Prothrombotic States and Hormonal Use. Hormonal contraception (oral contraceptive pills and transdermal patches... Laboratory Investigation Fibrinolysis Myeloproliferative Disorders and Stroke Heparin-Induced Thrombocytopenia Antiphospholipid Antibodies Sneddon Syndrome Homocystinuria and Homocystinemia Thrombotic Thrombocytopenic Purpura Emerging Treatments for iTTP: Rituximab and Caplacizumab Current Treatment Sickle Cell Disease Screening of Patients With Stroke for Coagulopathies 43 - Migraine and Stroke Clinical Features Classification Migrainous Cerebral Infarction Coexisting Stroke and Migraine Stroke With Clinical Features of Migraine Symptomatic Cases Migraine Mimic Uncertain Classification Epidemiology Potential Factors Increasing the Risk of Stroke Among Patients With Migraine Neuroimaging Magnetic Resonance Imaging Positron Emission Tomography Headache of Vascular Disease Drug-Induced Migraine-Related Stroke Angiography Transient Focal Neurologic Events and Late-Onset Migraine Accompaniments Hemorrhage Retinal or Ocular Migraine Migraine That Mimics Stroke Hemiplegic Migraine Migraine With Brain Stem Aura Mechanisms Migraine and Patent Foramen Ovale Stroke Prevention in Patients With Migraine Treatment of Migraine Attacks in Patients at Risk For Stroke or in Patients With Transient Ischemic Attack or Stroke 44 - Cryptogenic Stroke Definitions Definition of Cryptogenic Ischemic Stroke Classification Schemes for Ischemic Stroke Etiologic Subtypes Probabilistic Approach to Etiologic Diagnosis Epidemiology and Diagnosis Prevalence of Cryptogenic Stroke Factors Influencing Prevalence of Cryptogenic Stroke Population Characteristics Diagnostic Testing Association Versus Causation Proposed Etiologies of Cryptogenic Stroke Under-Classified Cryptogenic Stroke Under-Measured Cryptogenic Stroke True Cryptogenic Stroke Why Cardiac Sources Are Suspected to Cause Cryptogenic Strokes Natural History of Cryptogenic Ischemic Stroke Management Implications of Cryptogenic Ischemic Stroke Acute Management Secondary Prevention Clinical and Research Issues for Cryptogenic Ischemic Stroke 45 - Cerebral Venous Thrombosis Introduction Epidemiology Venous Anatomy Pathophysiology Etiology Clinical Aspects Diagnosis Computed Tomography Computed Tomographic Venography Magnetic Resonance Magnetic Resonance Venography Intra-arterial Angiography Transcranial Doppler D-Dimer Prognosis Treatment Antithrombotic Treatment Endovascular Treatment Prevention of Thrombotic Events After the Acute Phase Symptomatic Treatment Treatment of Intracranial Hypertension Treatment and Prevention of Seizures Contraception and Future Pregnancies SECTION V Diagnostic Studies 46 - Ultrasonography Introduction Applied Principles of Ultrasound Physics Extracranial Ultrasound Assessment Intima-Media Thickness Early Carotid Plaque Identifying High-Risk Plaques Carotid Artery Stenosis Carotid Artery Dissection Fibromuscular Dysplasia Inflammatory Disease of the Carotid Arteries Vertebral Artery Stenosis Vertebral Artery Dissection Transcranial Doppler Introduction Clinical Indications and Expected Outcomes Acute Cerebral Ischemia Intracranial Collateralization and Reversed Robin Hood Syndrome Vasomotor Reactivity Emboli and Right-to-Left Shunt Detection Intracranial Stenosis Cerebral Vasospasm After Subarachnoid Hemorrhage Cerebral Circulatory Arrest Subclavian Steal Insufficient Transcranial Bone Windows Echocontrast Studies Ultrasound in Stroke Therapy Assessment of Recanalization After Thrombolysis Sonothrombolysis Ultrasound-Enhanced Tissue Plasminogen Activator Thrombolysis Clot Lysis With Ultrasound and Microbubbles Without Thrombolytic Agents Sonothrombolysis of Spontaneous Intracranial Hemorrhage Brain Perfusion Imaging Monitoring of Carotid Stenting, Endarterectomy, and Endovascular Reperfusion New Trends in Ultrasound Molecular Imaging Opening the Blood-Brain Barrier Targeted Drug Delivery With Ultrasound Ultrasound-Enhanced Gene Therapy 47 - Computed Tomography-Based Evaluation of Cerebrovascular Disease Noncontrast Computed Tomography Feasibility and Technical Capacity Downsides of Computed Tomography Imaging Detection of Hypodense Tissue on Computed Tomography Early Signs of Infarction on Noncontrast Computed Tomography Diagnostic Accuracy Diagnostic Impact Therapeutic Impact Prognostic Impact Computed Tomography Angiography Feasibility and Technical Capacity Diagnostic Accuracy Intracranial Disease Extracranial Carotid Artery Disease Detection of Brain Tissue Infarction Diagnostic Impact Therapeutic Impact Computed Tomography Perfusion Imaging Technical Capacity and Feasibility Diagnostic Accuracy Thresholds and Diffusion-Weighted Image and Magnetic Resonance Perfusion Diagnostic Impact Therapeutic and Prognostic Impact Posterior Circulation Computed Tomography Imaging Ischemic Stroke Noncontrast Computed Tomography and Computed Tomography Angiography in Acute Hemorrhagic Stroke 48 - Magnetic Resonance Imaging of Cerebrovascular Diseases General Principles of Magnetic Resonance Imaging T1-Weighted Images T2-Weighted Images Proton Density Images Fluid-Attenuated Inversion Recovery Images Diffusion-Weighted Imaging Magnetic Resonance Perfusion Imaging Magnetic Resonance Angiography Susceptibility-Weighted Imaging Magnetic Resonance Spectroscopy Clinical Applications of MRI in Patients With Cerebrovascular Disease Transient Ischemic Attacks Conventional MRI Diffusion-Weighted MRI Magnetic Resonance Perfusion Implications of MRI for Transient Ischemic Attack Definition and Clinical Guidelines Ischemic Stroke The Subacute Stroke Stage. When infarcts evolve, their MR characteristics gradually change. Subacute infarcts are characterized ... The Chronic Stroke Stage. In the chronic stage of stroke, the edema that was present in the subacute phase has resolved. At very... Ischemic Lesions on MRI in Patients Without a Clinical Stroke. Focal hyperintensities in the subcortical white matter demonstrat... Diffusion-Weighted MRI Test Characteristics of Diffusion-Weighted Imaging. DWI has a high degree of sensitivity (88%–100%) and specificity (95%–100%) f... Clinical Utility of Diffusion-Weighted Imaging. DWI’s high sensitivity and specificity for identifying acute infarcts and its ab... Magnetic Resonance Perfusion Magnetic Resonance Spectroscopy Clinical Utility of Magnetic Resonance Spectroscopy in Stroke. While MR spectroscopy can theoretically be used to refine the MR ... Intracranial Hemorrhage Intraparenchymal Hemorrhage Microbleeds Hemorrhagic Transformation Subarachnoid Hemorrhage Superficial Siderosis Subdural and Epidural Hematomas. Subdural hematomas appear as crescent-shaped lesions adjacent to the brain parenchyma. The MRI ... Cerebrovascular Pathology Arterial Stenosis and Occlusion Arterial Plaque Morphology Arterial Dissection Aneurysms Venous Thrombosis MRI-Guided Acute Stroke Therapy Clinical Trials of Intravenous Thrombolysis Endovascular Therapy 49 - Cerebral Angiography Technique Risks Angiographic Cerebral Vasculature: Normal Anatomy Indications Intracranial Hemorrhage Ischemia Cerebral Infarction and Transient Ischemic Attack Acute Ischemia Arteriovenous Malformations Cervicocephalic Artery Dissection Vasculitis Fibromuscular Dysplasia Moyamoya Syndrome Cerebral Arterial Vasospasm Cerebral Venous Thrombosis Idiopathic Intracranial Hypertension Brain Death 50 - OMICs in Stroke: Insight Into Stroke Through Epigenomics, Transcriptomics, Proteomics, Lipidomics, and Metabolomics Introduction Epigenomics DNA Methylation Histone Modifications MicroRNA (Short Noncoding RNA, miRNA), Plasma, Blood/Leukocytes/Platelets Noncoding RNA (lncRNA) Transcriptomics Stroke Diagnosis Ischemic Stroke Versus Controls Ischemic Stroke Versus Hemorrhagic (Intracerebral Hemorrhage) Stroke Transient Ischemic Attack Stroke Etiology Cardioembolic Versus Large Vessel Versus Small Vessel Cryptogenic Lacunar Stroke and Cerebral White Matter Hyperintensities Stroke Biology and Complications Sexual Dimorphic Gene Expression Hemorrhagic Transformation Smoking Proteomics Stroke Diagnosis Ischemic Stroke Versus Controls Ischemic Stroke Versus Intracerebral Hemorrhage Transient Ischemic Attack Stroke Etiology Cardioembolic Large Vessel Small Vessel Stroke Biology and Complications Early Neurologic Deterioration Hemorrhagic Transformation Outcomes Stroke Recurrence, Plaque Progression, Instability Response to Therapy Infection Metabolomics Diagnosis Ischemic Stroke Versus Controls Ischemic Stroke Versus Hemorrhagic Stroke Transient Ischemic Attack Cardioembolic. Valine, leucine, and isoleucine decreased in plasma of patients with cardioembolic stroke compared to controls.82... Prognosis. In cardioembolic stroke patients, lower branched chain amino acid levels also correlated with poor neurologic outcome... Lipidomics Diagnosis Ischemic Stroke Versus Controls Etiology Determination Large Vessel Small Vessel Stroke Biology and Complications Hemorrhagic Transformation Stroke Risk Conclusions SECTION VI Therapy PART A Medical Therapy 51 - Stroke Systems of Care and Impact on Acute Stroke Treatment Thrombolysis and Thrombectomy—Demographics Global Rates of Thrombolysis and Thrombectomy Changing Stroke Demographics and Characteristics and Predicted Impact on Thrombolysis and Thrombectomy Existing and Projected Distribution of Thrombolysis Centers Worldwide Where Should Thrombolysis Be Done Challenges in Thrombolysis Treatment and Development of Designated “Stroke Centers” Existing and Projected Distribution of Thrombectomy Centers Worldwide Where Should Thrombectomy be Done Centralized Versus Distributed Model Who Is Carrying Out Thrombolysis and Who Should Do It in the Future Who Is Carrying Out Thrombectomy and Who Should Do It in the Future Current Guidelines for Training for Thrombolysis and Thrombectomy Thrombolysis and Thrombectomy—How to Get the Right Patient to the Right Hospital Prehospital Screening—Accuracy of Emergency Medical Services in Identifying Stroke Patients, Thrombolysis Candidates, Large Vess... Drip and Ship—Safety, What Is an Acceptable Time Delay, What Imaging Should Be Done and Where “Commando” Approach—Mobile Stroke or Thrombectomy Teams Telestroke and Other Innovations to Expand and Speed Treatment Mobile Stroke Units—Status and Future Perspective 52 - Prehospital and Emergency Department Care of the Patient With Acute Stroke Introduction The Course of Events for the Acute Stroke Patient Prehospital Components Emergency Department Recognition of Stroke Symptoms by the Patient or Family Members First Contact With Medical Care Dispatch of Prehospital Providers Prehospital Evaluation and Management Prehospital Identification of Stroke Mobile Stroke Units and Future Considerations Emergency Department Care of the Stroke Patient Initial Emergency Department Triage Emergency Department Evaluation and Management Airway Breathing Circulation Hypotension Electrocardiogram Abnormalities and Acute Cardiovascular Dysfunction Hyperglycemia Emesis Pyrexia Seizures Cerebral or Cerebellar Herniation Syndromes Management of Acute Neurologic Changes and Suspected Strokes Evaluation and Management of Acute Stroke Cases in the ED—the “Code Stroke” Diagnostic Studies Stroke Mimics Initial Imaging and Management Computed Tomographic Perfusion or Magnetic Resonance Perfusion Subsequent Care After Imaging WAKE-UP Magnetic Resonance Imaging and WAKE-UP Thrombolysis Special Consideration: Transient Ischemic Attacks Management of Intracerebral Hemorrhage Management of Coagulopathy (Vitamin K Antagonists and Direct Oral Anticoagulants) Disposition Summary/Conclusion 53 - Intravenous Thrombolysis Thrombosis and Thrombolysis Endogenous Plasminogen Activators Tissue-Type Plasminogen Activator Urokinase Novel Plasminogen Activators Microplasmin Exogenous Plasminogen Activators Streptokinase Plasminogen Activators Derived From Saliva of Desmodus rotundus Ancrod Preclinical Studies of Thrombolysis for Acute Stroke Clinical Studies of Thrombolysis for Acute Stroke Feasibility Studies ECASS The NINDS Studies ECASS II Streptokinase Trials The ATLANTIS Study SITS-MOST SITS-ISTR ECASS III IST-3 Pooled Analysis NINDS A, NINDS B, ECASS I, ECASS II, ATLANTIS A, ATLANTIS B, ECASS III, EPITHET, IST-3.61,62 To firmly establish... Enchanted Tenecteplase Trials Guidelines for Intravenous Thrombolysis in Acute Stroke—Then and Now Time Window Thrombolysis in the Context of Mechanical Thrombectomy Current Guidelines per American Heart Association/American Stroke Association Use of Heparin in the Last 24 Hours With a Prolonged Partial Thromboplastin Time Platelet Count Less Than 100,000 cells/mm3 Prior Stroke Within the Last 3 Months Severe Head Trauma Within the Last 3 Months Major Surgery Within the Last 14 Days Rapidly Improving Neurologic Signs Isolated Mild Neurologic Deficits Prior Intracerebral Hemorrhage Blood Glucose Level Less Than 50 mg/dL or Greater Than 400 mg/dL Seizure at the Onset of Stroke Gastrointestinal or Genitourinary Bleeding Recent (Within 3 Months) Myocardial Infarction Infective Endocarditis. IV thrombolysis is contraindicated in patients whose stroke is thought to be a result of septic emboli, ... Additional Treatment Considerations Early Computed Tomography Findings Are Not Contraindications to Treatment Generalized Efficacy of Tissue Plasminogen Activator for Acute Stroke Recanalization and Arterial Reocclusion After Tissue Plasminogen Activator Treatment Management During and After Thrombolytic Treatment Predictors of Good Outcome With Thrombolytic Treatment Risks of Thrombolysis Cost-Effectiveness of Thrombolysis Combination Treatment Conclusion 54 - Antithrombotic Therapy for Treatment of Acute Ischemic Stroke Rationale Pharmacology Heparin, Low-Molecular-Weight Heparins, and Danaparoid Other Anticoagulants Antiplatelet Agents Safety of Emergency Antithrombotic Treatment for Patients With Acute Ischemic Stroke Heparin Low-Molecular-Weight Heparins and Danaparoid Other Anticoagulant Agents New Oral Anticoagulants Antiplatelet Agents Combined Antithrombotic and Thrombolytic Therapy Dual Oral Antiplatelet Therapy Conclusions Efficacy of Treatment of Acute Ischemic Stroke Unfractionated Heparin Low-Molecular-Weight Heparins and Danaparoid Antiplatelet Agents Conclusions Preventing Early Recurrent Stroke Halting Neurologic Worsening Improving Neurologic Outcomes Prevention of Deep Vein Thrombosis Other Indications Current Status of Antithrombotic Therapy Future of Antithrombotic Therapy 55 - General Stroke Management and Stroke Units Introduction Stroke Unit Care Stroke Unit Design Availability of Stroke Unit Care General Stroke Management Reassess the Patient Medically and Neurologically Ascertain Definite Stroke Diagnosis and Rule Out Stroke Mimics Establish Stroke Etiology Unstable Cerebral Ischemia and Progressing Stroke Achieve and Maintain Vital Functions Within or Close to Physiologic Ranges (Homeostasis) Fluid and Electrolyte Balance Body Temperature Blood Glucose Blood Pressure Prevent, Diagnose, and Treat Complications Brain Edema and Elevated Intracranial Pressure Hemorrhagic Transformation Seizures Early Recurrent Stroke Delirium Depression Electrolyte Disorders Cardiovascular Complications Tissue Oxygenation and Respiratory Failure Pneumonia Urinary Tract Infection Dysphagia and Malnutrition Constipation Pulmonary Embolism and Deep Vein Thrombosis Decubitus Ulcer Complications Specific to Intracerebral Hemorrhage Complications Specific to Subarachnoid Hemorrhage Detect Risk Factors and Start Preventive Measures for Avoiding Recurrences Start Early Rehabilitation Be Active in Stroke Research and Education When Hope is Lost, Remember Organ Donation Conclusions Acknowledgment 56 - Critical Care of the Patient With Acute Stroke General Principles IN THE CARE OF THE CRITICALLY ILL STROKE PATIENT Initial Assessment of Patients With Stroke Ancillary Tests and In-House Transportation Clinical Examinations Pulmonary Function and Mechanical Ventilation Sedation and Analgesia Benzodiazepines Propofol Ketamine α-2-Agonists and Other Sedatives Analgesics Fluid and Electrolyte Balance Nutrition Blood Pressure Control Lowering High Blood Pressure Peripheral Vasodilators Anti-Adrenergic Agents Calcium Channel Blockers Angiotensin-Converting Enzyme Inhibitors Maintaining or Elevating Blood Pressure Invasive Systemic Monitoring Central Venous Line Arterial Line Pulse Contour Analysis Invasive Monitoring of Intracranial Pressure Intraventricular Catheters. For many years, intraventricular catheters (IVCs, or external ventricular drains [EVDs]) were the on... Epidural Catheters. Epidural ICP monitoring is the least invasive approach but also the one most vulnerable to artifacts. Bruder... Intraparenchymal Microtransducers. Catheter-tip intraparenchymal ICP measurement is a popular alternative to the ventricular cat... Multimodality Neuromonitoring Treatment of Raised Intracranial Pressure Basic Measures Hyperventilation. Hyperventilation results in reduction in arterial pressure of carbon dioxide (PaCO2), which causes vasoconstri... Barbiturates. The main effects of barbiturates are decreases in cerebral metabolism and CBF; the mechanism of these changes is u... Glucocorticoids. There has been ample prior research exploring the use of glucocorticoids in stroke, both ischemic and hemorrhag... Hemicraniectomy. Decompressive surgery is based on mainly mechanical considerations. The vector of brain extension is reverted o... Temperature Management Glyburide (Glibenclamide) Antiepileptic Therapy Prevention of Deep Vein Thrombosis and Pulmonary Embolism Management of Blood Glucose Specific Treatment of Various Stroke Syndromes Large Middle Cerebral Artery Stroke Thrombolytic and Endovascular Therapies Neuromonitoring. Neuromonitoring pre- and post-intervention AIS is a mainstay, with the primary aims directed at minimizing morb... Hemodynamic Management. BP management is a critical issue in the treatment of acute stroke. Both, hyper- and hypotension can be ... Hemicraniectomy. The most effective treatment of malignant MCA syndrome not amenable to revascularization by means of thrombolys... Temperature Management Moderate Hypothermia Acute Basilar Artery Occlusion Cerebellar Infarction Spontaneous Intracerebral Hemorrhage Reversal of Anticoagulation. As coagulation status of a patient with ICH may affect both the progression of cerebral bleeding an... Re-initiation of Anticoagulation. Certain subgroups of ICH patients, especially those with mechanical heart valves, atrial fibri... Thrombocytes. A significant proportion of ICH patients are on antiplatelet therapy (APT) mostly for secondary prevention of card... Blood Pressure Management. Severe hypertension is frequently observed in patients with ICH. Hypertensive peaks might cause rhexi... Neurosurgery. Surgery for sICH is covered in a separate section of this book (see Chapter 72) and will therefore be mentioned on... Intraventricular Hemorrhage and Hydrocephalus. Isolated IVH (iIVH) in adults is rare and might occur due to intraventricular vas... Cerebral Edema. Cerebral perihematomal edema and its effects have been discussed above. None of the conventional treatment strat... Prevention of Deep Vein Thrombosis. Immobilized patients with ICH are at high risk for thrombosis and thromboembolic events.400 ... Cerebral Venous and Sinus Thrombosis. Less than approximately 1% of all strokes are caused by CVST. CVST is more frequent in you... Conclusion 57 - Pharmacologic Modification of Acute Cerebral Ischemia Background: Preclinical and Clinical Cytoprotection The Definition and Role of Cytoprotection Targets of Cytoprotection: The Ischemic Cascade Preclinical Stroke Models Preclinical Testing of Cytoprotective Therapies The Need for Careful Physiologic Monitoring Penumbra as Target Reperfusion Injury Downstream Targets. Many of the initial events in the ischemic cascade, such as release of glutamate and increase in intracellul... Multimodality Therapy Early Pharmacologic Intervention May Influence Functional Recovery Relevance of Animal Models Standardization of Stroke Sample Size Time Coupling Cytoprotection With Reperfusion Dose More Sensitive Outcome Measures Clinical Cytoprotective Therapy Trials Calcium Antagonists Glutamate Antagonists Agents Acting Indirectly on Glutamate Other Neurotransmitter Modulators Free Radical Scavengers, Adhesion Molecule Blockers, Steroids, and Other Anti-inflammatory Strategies Membrane “Stabilizers” and Trophic Factors Hypothermia Caffeinol Blood Substitutes and Oxygen Delivery Conclusion 58 - Treatment of “Other” Stroke Etiologies Vascular Disorders Noninflammatory Vasculopathies Arterial Dissection5,6 Fibromuscular Dysplasia Vasospasm After Subarachnoid Hemorrhage Reversible Cerebral Vasoconstriction Syndromes Radiation-Induced Vasculopathy Moyamoya Disease Hyperhomocyst(e)inemia and Homocystinuria Fabry Disease Inflammatory Vasculopathies Isolated Angiitis of the Central Nervous System Amyloid Angiitis and Cerebral Amyloid Angiopathy-Related Inflammation Temporal (Giant Cell) Arteritis Cerebral Vasculitis Related to Collagen Vascular Disorders Cerebral Vasculitis Related to Infection Cerebral Vasculitis Related to Toxins Cerebral Vasculitis Related to Neoplasms Hematologic Disorders Prothrombotic Disorders Defects of the Coagulation System Antiphospholipid Antibody Syndrome Disseminated Intravascular Coagulation Sickle Cell Disease Miscellaneous Disorders Migraine-Related Stroke Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes Cerebral Venous Thrombosis 59 - Medical Therapy of Intracerebral and Intraventricular Hemorrhage Emergency Department Management The Importance of Intensive Medical Therapies Stroke Units and Intensive Care Units Fever Hyperglycemia Hypertension Deep Vein Thrombosis Steroids Anticonvulsants Other Therapies Prevention of Hematoma Expansion Management of Cerebral Edema, Hydrocephalus, and Intraventricular Hemorrhage Cerebral Edema Hydrocephalus and Intraventricular Hemorrhage Intracranial Pressure Considerations Selection of Patients for Surgery Special Considerations in Anticoagulant-Related Intracranial Hemorrhage Restarting Antithrombotic Medications After Intracerebral Hemorrhage Predictors of Outcome and Withdrawal of Life-Sustaining Treatments Conclusions 60 - Rehabilitation and Recovery of the Patient With Stroke Mechanisms for Gains Assessing Impairment, Disability, Activity, and Quality of Life Organization of Services Rehabilitation-Related Medical Complications Bladder Dysfunction Musculoskeletal and Central Pain Depression Fatigue Dysphagia Sexual Dysfunction Sleep Disorders Spasticity Overview of Practices Cognitive Rehabilitation Memory Disorders Visuospatial and Attentional Disorders Speech and Language Impairment Motor Rehabilitation Mobility Training Natural History for Walking Gains Interventions Task-Oriented Training Strengthening and Fitness Exercise Upper Extremity and Self-Care Skills Natural History General Interventions Task-Oriented Approaches Other Training and Augmentative Strategies Pharmacotherapy Conclusions 61 - Interventions to Improve Recovery After Stroke Biology of Stroke Recovery Suggests Therapeutics Targets Repair-Based Therapies are Distinct From Acute Therapies Repair-Based Therapies Under Study Drugs Serotonergic Dopaminergic Amphetamines Other Drugs Biologic Agents Growth Factors Monoclonal Antibodies Stem Cells Activity-Based Therapies Rehabilitation Therapy High Doses of Activity-Based Therapy Choice of Computer Interface for Activity-Based Therapy Activity-Based Therapy Targeting the Lower Extremity Robotics Functional Electrical Stimulation Cognitive-Based Therapies Brain Stimulation Transcranial Magnetic Stimulation Transcranial Direct Current Stimulation Other Forms of Brain Stimulation Lesion Bypass Brain-Computer Interface Principles of Repair-Based Clinical Trials After Stroke Time Is an Important Factor for Repair-Based Therapies Neural Repair Is Experience-Dependent Measuring Effects of Repair-Based Therapies Is Aided by Using Modality-Specific Measures Repair-Based Therapies Do Not Benefit From a One-Size-Fits-All Approach Issues in Clinical Trials of Repair-Based Therapies 62 - Enhancing Stroke Recovery With Cellular Therapies What are Cell Therapies Mechanisms, Rationale, and Temporal Windows Different Cell Types and Their Categorization Delivery Routes Steps Guidelines for Translation From Bench to Clinical Spectrum of Different Cell Types Adult-Derived Tissues Bone Marrow Mononuclear Cells. Mononuclear cells (MNCs) are a mixture of different types of cells and contain most of the different stem cel... Mesenchymal Stem Cells. Within MNCs lies a more specific population of mesenchymal cells residing in the stromal compartment of ... Multipotent Adult Progenitor Cells. The bone marrow also contains stem cells that may be more primitive than MSCs displaying plu... Adipose Studies also suggest that adipose tissue contains pluripotent stromal cells. Stem cell density may be 500–1000 times more than b... Dental Stem Cells The dental pulp represents another source of stem cells that show similarities with other stem cells in the nervous system and t... Birth-Derived Tissues Umbilical Cord Blood Cells. Cord blood contains an enriched fraction of progenitor cells, but also several other different cell ... Placenta. Human placenta-derived adherent cells (PDACs) are a mesenchymal-like cell population derived from normal human placent... Neural Stem Cells. NSCs are a group of ectodermal progenitor cells, which can differentiate into committed neural subtypes, such... Amniotic Cells. The amniotic membrane (AM) is an avascular tissue that forms the innermost layer of the fetal membranes and has ... Inducible Pluripotent Stem Cells. In its own category, we discuss inducible pluripotent stem cells (iPS). Technological advancem... Extracellular Vesicles Clinical Trials Overview Bone-Marrow Mononuclear Cell Studies Marrow Stromal Cell Studies Aldehyde Dehydrogenase Bright Cells Stem cells can also be isolated from the bone marrow by the expression of enzymes. For example, cell populations that express hi... Allogeneic Multistem Trial Multistem cells are the trademark name for MAPCs by Athersys and are derived from bone marrow. They have been shown to modulate ... Clinical Trials Testing Intracerebral Administration of Stem Cells In the past few years, cell therapy platforms have emerged to bring forward new stem cell treatments by intracranial administrat... Future Directions 63 - Antiplatelet Therapy for Secondary Prevention of Stroke UNDERSTANDING Platelet Physiology in the Planning of Antiplatelet Therapy Normal Functions of Platelets in Hemostasis Participants in the Initial Platelet Response to Vascular Injury Platelet Membrane Components Mediating Platelet Activation Platelet Adhesion Platelet Aggregation Platelet Membrane Receptors in Aggregation Multiple Independent Pathways to Aggregation Platelet Release Reaction Platelet Synthesis of Vasoactive Lipid Mediators How Platelet Activation Promotes Blood Coagulation Platelet Participation in Fibrinolysis and Thrombolysis Physiologic Mechanisms That Limit Platelet Activation Platelet Activation as a Link Between Hemostasis and Inflammation Platelet Function in Patients At Risk of Occlusive Stroke Factors Contributing to Platelet Hyperactivity Role of Platelet Count Chronic Changes in Platelet Reactivity in Stroke-Prone Patients Antiplatelet Drugs IN STROKE PREVENTION Aspirin Mechanism of the Antiplatelet Effect of Aspirin Pharmacokinetics of Aspirin Dose–Response Effects Range and Limits of Aspirin Effects on Platelet Function Aspirin Resistance Measurement of Aspirin Effects on Platelets. Because platelet activation leads to a change in platelet shape and aggregation as ... In Vivo Tests In Vitro Tests Mechanisms of Aspirin Resistance. Several factors have been mentioned and investigated as related to aspirin resistance, but so ... Aspirin Resistance and Stroke Recurrence. Data regarding the percentage recurrence of ischemic stroke in patients treated with a... Therapeutic Management of Aspirin Resistance. Because aspirin resistance seems to be a multifactorial phenomenon, different fact... Aspirin Toxicity Mechanism of Action Pharmacokinetics and Dosing Clopidogrel Resistance Antiplatelet Agents in Primary Prevention of Stroke In Women In Diabetic Patients Aspirin in Prevention of Early Stroke Recurrence Antiplatelet Agents in Secondary Prevention of Noncardioembolic Stroke Antiplatelets in Comparison With Warfarin Antiplatelet Agents as Monotherapy and in Combination for Secondary Stroke Prevention Aspirin. In meta-analysis by the ATTC, aspirin was associated with a 23% reduction in the combined events of stroke, MI, and vas... Aspirin Plus Dipyridamole. The European Stroke Prevention Study (ESPS)-2 randomly assigned patients with ischemic stroke or TIA ... Clopidogrel. The Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial investigated the effects of cl... Aspirin Plus Dipyridamole Versus Clopidogrel. Before the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) tr... Antiplatelet Agents in Secondary Prevention of Cardioembolic Stroke Combinations of Antiplatelet Agents Aspirin and Thienopyridines Ischemic Strokes Antiplatelet Therapy in Carotid Endarterectomy and Carotid Artery Stenting OTHER ANTIPLATELET AGENTS Ticagrelor Cilostazol Terutroban Interaction of Antiplatelet Agents and Nonsteroidal Antiinflammatory Drugs Antiplatelet and Cerebral Microbleeds Conclusions 64 - Secondary Prevention of Cardioembolic Stroke Atrial Fibrillation Long-Term Monitoring for Detection of Atrial Fibrillation “Atrial Cardiopathy” as a Cause of Cardioembolic Stroke Stroke Prevention in Atrial Fibrillation Warfarin Combined With Antiplatelet Agents New Antithrombotic Agents Dabigatran Rivaroxaban Apixaban Edoxaban Reversal Agents Comparison of New Oral Anticoagulants Left Atrial Appendage Occlusion for Stroke Prevention in Atrial Fibrillation Cardiomyopathies Myocardial Infarction Valvular Heart Disease Rheumatic Mitral Valve Disease Prosthetic Cardiac Valves Infectious Endocarditis Patent Foramen Ovale Aortic Arch Disease Summary Definitions of Classes and Levels of Evidence Used Therapeutic Recommendations 65 - Design of Stroke-Related Clinical Trials When Can a Stroke-Related Trial be Conducted Types of Prevention Trials Therapeutic Trials The Phases of Clinical Trials Phase 1 Phase 2 Phase 3 Outcome Measures Inclusion and Exclusion Criteria for Phase 3 Randomization Recruitment Adherence to Treatment and Trial Follow-Up Measuring Adherence to Treatment Data Analyses Missing Data Adaptive Designs Sample Size Study-Level and Patient-Level Meta-Analyses Protocol, Manual of Procedures, and Statistical Analysis Plan Training Regulations and Guidelines PART B Interventional Therapy 66 - Endovascular Therapy of Extracranial and Intracranial Occlusive Disease Carotid Artery Stenosis Carotid Stenosis and Stroke Risk Randomized Trials of Carotid Angioplasty and Stenting Versus Carotid Endarterectomy Endarterectomy Versus Stenting in Patients With Symptomatic Severe Carotid Stenosis Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial Carotid Web Embolic Protection Devices Stents Restenosis Rates Timing of Revascularization in Symptomatic Stenosis Extracranial Vertebral Artery Stenosis Angioplasty and Stenting Intracranial Atherosclerosis Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Study Wingspan Stent System Post Market Surveillance Study Lessons From Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Study Future Directions of Intracranial Atherosclerotic Disease Treatment 67 - Endovascular Treatment of Acute Ischemic Stroke Introduction Mechanical Thrombectomy Endovascular Techniques and Devices Stent Retrievers Aspiration Thrombectomy Anterior Circulation Early Time Window Individual Patient-Level Data Meta-Analyses of Randomized Controlled Trials Aspiration Thrombectomy Compared With Stent Retriever Thrombectomy Combined Stent Retriever and Aspiration Thrombectomy Compared With Stent Retriever or Aspiration Alone Late Time Window Clinical Practice Guideline Recommendations Posterior Circulation Time to Angiographic Reperfusion and Clinical Outcome After Acute Ischemic Stroke Organization of Systems of Care for Acute Ischemic Stroke Future Directions Mild Stroke Symptoms Distal Occlusions Large Infarct Core Tandem Occlusions Pediatric Patients Conclusion 68 - Endovascular Treatment of Intracranial Aneurysms Historical Overview Evidence for Endovascular Treatment of Ruptured Aneurysms Evidence for Endovascular Treatment of Unruptured Aneurysms Techniques of Endovascular Aneurysm Treatment Coiling Balloon-Assisted Coiling Stent-Assisted Coiling Flow Diversion Intra-Aneurysmal Flow Disruption Liquid Embolics Preprocedural Management: Unruptured Aneurysms Preprocedural Management: Ruptured Aneurysms Intraprocedural Management Postprocedural Management Summary 69 - Interventional Therapy of Brain and Spinal Arteriovenous Malformations Introduction Brain Arteriovenous Malformations Classification of Vascular Malformations in General Natural History Genetic Considerations Angiographic Analysis Concepts of Treatment Unruptured Arteriovenous Malformations Ruptured Arteriovenous Malformations Liquid Embolic Materials Particles/Microcoils/Coils Specific Treatment Considerations Flow-related Arterial Aneurysms Fistulous Arteriovenous Malformations Cerebral Proliferative Angiopathy Cerebrofacial Arteriovenous Metameric Syndromes Indications and Contraindications of Endovascular Therapies Spinal Arteriovenous Malformations Spinal Cord Vascularization Natural History Angioarchitectural Classification Fistulous Arteriovenous Malformations Nidal-Type Arteriovenous Malformations Pathophysiologic Classification Concepts of Treatment Fistulous Arteriovenous Malformations Nidal-Type Arteriovenous Malformations Indications and Contraindications of Endovascular Therapies 70 - Dural Arteriovenous Malformations Introduction Clinical Presentation Pathophysiology and Lesion Evolution Diagnostic Imaging Lesion Classification Indications for Treatment Treatment Options Endovascular Techniques Microsurgical Treatment Radiosurgical Treatment Comprehensive Management Strategy PART C Surgical Therapy 71 - Surgery of Anterior and Posterior Aneurysms Anterior Circulation Internal Carotid Artery Ophthalmic Segment Aneurysms Anatomy and Terminology Surgical Approaches Communicating Segment (Posterior Communicating Artery) Aneurysms Anatomy and Terminology Surgical Approaches Choroidal Segment (Anterior Choroidal Artery) Aneurysms Anatomy and Terminology Surgical Approaches Internal Carotid Artery Bifurcation Aneurysms Anatomy and Terminology Surgical Approaches Anterior Communicating Artery Aneurysms Anatomy and Terminology Surgical Approaches Distal Anterior Cerebral Artery Aneurysms Anatomy and Terminology Surgical Approaches Middle Cerebral Artery Aneurysms Anatomy and Terminology Surgical Approaches Posterior Circulation Basilar Apex Aneurysms Anatomy and Terminology Surgical Approaches Anterior Subtemporal Approach Temporopolar Approach Distal Posterior Cerebral Artery and Superior Cerebellar Artery Aneurysms Basilar Trunk Aneurysms Vertebral Artery Trunk and Posterior Inferior Cerebellar Artery Aneurysms Anatomy and Terminology Surgical Approaches Distal Posterior Inferior Cerebellar Artery Aneurysm Anatomy and Terminology Surgical Approaches 72 - Surgery for Intracerebral Hemorrhage Introduction Pathophysiologic Rationale for Surgical Evacuation A Brief History of Surgery for Intracerebral Hemorrhage Modern Minimally Invasive Evacuation Techniques Meta-Analyses of Trials Evaluating Minimally Invasive Evacuation Techniques Craniopuncture Endoscopic Evacuation Endoscope-Assisted Evacuation Endoport-Mediated Evacuation Evaluation, Imaging, and Early Management of the Surgical Patient Postoperative Management of the Surgical Patient Alternative Diagnoses and Associated Management Intracerebral Hemorrhage Associated With Anticoagulation Use Intracerebral Hemorrhage Secondary to Aneurysmal Rupture Intracerebral Hemorrhage Secondary to Arteriovenous Malformation Intracerebral Hemorrhage Secondary to Hemorrhagic Transformation of Ischemic Stroke The Surgical Management of Cerebellar Hemorrhage Future Directions in a Fast-Moving Field 73 - Management of Intraventricular Hemorrhage Introduction Primary Intraventricular Hemorrhage Hypertensive Brain Hemorrhage and Intraventricular Hemorrhage Aneurysmal Intraventricular Hemorrhage Vascular Malformations and Intraventricular Hemorrhage Natural Clearance of Intraventricular Hemorrhage Clinical Features Diagnosis Treatment Placement of External Ventricular Drain Catheters Thrombolysis Through the External Ventricular Drain Systemic Anticoagulation Effects. A subgroup analysis of the CLEAR IVH phase II trial assessed the systemic effects of intravent... Key Lessons and Future Directions. The lessons learned from the CLEAR trials have proven to be vital for deploying safe minimall... Other Surgical Interventions for Intraventricular Hemorrhages Prognosis 74 - Surgical Management of Cranial and Spinal Arteriovenous Malformations Introduction Cerebral Arteriovenous Malformations Definition and Pathogenesis Natural History Clinical Presentation Lesion Classification Surgical Considerations Ruptured Arteriovenous Malformations Unruptured Arteriovenous Malformations Microsurgical Technique Deep Hemispheric Arteriovenous Malformations Arteriovenous Malformations of the Posterior Fossa Cerebral Aneurysms Associated With Arteriovenous Malformations Multimodality Treatment of Arteriovenous Malformations Arteriovenous Malformation Management During Pregnancy Perioperative Management Cerebral Arteriovenous Malformations Summary Spinal Arteriovenous Malformations Extradural Arteriovenous Fistulas Intradural Dorsal Arteriovenous Fistulas Intradural Ventral Arteriovenous Fistulas Extradural-Intradural Arteriovenous Malformations Intramedullary Arteriovenous Malformations Conus Medullaris Arteriovenous Malformations Spinal Arteriovenous Malformations Summary Abbreviations Disclosures and Financial Support Acknowledgments 75 - Surgical Management of Cavernous Malformations and Venous Anomalies Natural History Epidemiology Pathophysiology Genetic Considerations Diagnostic Imaging NonOperative Management Neurosurgical Considerations Stereotactic Radiosurgery Stereotactic Laser Ablation Venous Anomalies Conclusions 76 - Indications for Carotid Endarterectomy in Patients With Asymptomatic and Symptomatic Carotid Stenosis Introduction Diagnosis Treatment Options Medical Treatment Carotid Revascularization Carotid Endarterectomy—Symptomatic North American Symptomatic Carotid Endarterectomy Trial European Carotid Surgery Trial Veterans Affairs Symptomatic Stenosis Trial Pooled Analysis Additional Considerations in Symptomatic Carotid Endarterectomy Carotid Endarterectomy—Asymptomatic Veterans Affairs Cooperative Study Group Asymptomatic Carotid Atherosclerosis Study Asymptomatic Carotid Surgery Trial Additional Considerations in Carotid Endarterectomy for Asymptomatic Stenosis Carotid Artery Stenting Conclusions 77 - Extracranial–Intracranial Bypass for Cerebral Ischemia Introduction Historical Background Flow Augmentation Bypass for Atherosclerotic Steno-occlusive Disease Bypass for Moyamoya Urgent Bypass for Acute Stroke Bypass for Vasospasm Posterior Circulation Flow Replacement Surgical Technique Positioning Superficial Temporal Artery Dissection Craniotomy Preparation of the Recipient Vessel Preparation of the Donor Vessel Anastomosis Closure Conclusion 78 - Decompressive Craniectomy for Infarction and Intracranial Hemorrhages Introduction Malignant Middle Cerebral Artery Infarction Pathophysiology Diagnosis Computed Tomography Magnetic Resonance Imaging Nuclear Imaging Treatment Modalities Nonoperative Treatment Extraventricular Drain Decompressive Craniectomy Complications Scientific Evidence Animal Studies Observational Studies Randomized Controlled Trials Younger Patients Older Patients Functional Outcomes Quality of Life Timing of Surgery Cerebellar Space-Occupying Infarctions Clinical Signs and Symptoms Surgical Indications Surgical Technique Clinical Outcomes Cerebellar Hemorrhage Surgical Indications and Techniques Clinical Outcomes Other Intracranial Hemorrhage Intraparenchymal Hemorrhage Subarachnoid Hemorrhage Conclusions for Clinical Practice Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
