The Stroke Book

Contents......Page 7
List of contributors......Page 9
Foreword......Page 13
Introduction......Page 15
Introduction......Page 17
The golden hour......Page 18
Pre-hospital stroke assessment instruments......Page 19
The Cincinnati pre-hospital stroke scale (CPSS)......Page 20
Facial movements......Page 21
Miami emergency neurological deficit (MEND)......Page 22
EMS pre-hospital management of the acute stroke patient......Page 23
Determining the stroke patient´s destination......Page 24
Bibliography......Page 25
2 Initial assessment of patients with stroke-like symptoms......Page 27
Vital signs......Page 28
Carotid/vertebral artery examination......Page 29
Cardiac examination......Page 31
Alert......Page 32
Language......Page 33
I; Olfactory......Page 35
III, Oculomotor; IV, Trochlear; VI, Abducens......Page 36
VII, Facial......Page 37
XII, Hypoglossal......Page 38
Rapid alternating movements......Page 39
Fine touch......Page 40
Romberg test......Page 41
NIH stroke scale (NIHSS)......Page 42
OCSP classification......Page 44
Toxic/metabolic encephalopathy......Page 45
Vestibular dysfunction......Page 46
Migraine......Page 47
Summary......Page 48
Bibliography......Page 49
Lacunar (penetrating artery)......Page 50
Location (radiologic syndromes)......Page 51
Localization......Page 52
Dissection......Page 53
Penetrating artery......Page 54
Borderzone......Page 55
Lateral medullary (Wallenberg)......Page 57
Posterior inferior cerebellar artery (PICA)......Page 58
Superior cerebellar artery (SCA)......Page 59
Penetrating artery......Page 60
Azygos paramedian artery (Percheron)......Page 61
Bibliography......Page 62
History and physical examination......Page 63
Initial diagnostics......Page 64
Arterial dissection......Page 65
Vasculopathies......Page 66
Vasculitides......Page 67
Cerebral vasospasm......Page 68
The pump: investingation of the heart......Page 69
Valvular disease......Page 70
Arrhythmia......Page 71
Hereditary thrombophilia......Page 72
Aquired thrombophilia......Page 73
Diagnosis......Page 74
Diagnosis......Page 75
Bibliography......Page 76
Introduction......Page 78
History and clinical examination......Page 79
Laboratory tests......Page 80
Computed tomography......Page 81
Magnetic resonance imaging......Page 83
Cerebral angiography......Page 84
General protocol......Page 85
Bibliography......Page 88
Temporal arteritis......Page 90
Other vasculitides......Page 93
Ehlers-Danlos syndrome......Page 94
Moyamoya syndrome......Page 95
Hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS)......Page 96
Arterial dissections......Page 97
Fabry's disease......Page 99
Homocystinuria......Page 100
Substance abuse......Page 101
Viral infections......Page 102
Intracranial mass lesion......Page 103
Seizures......Page 104
Posterior reversible encephalopathy syndrome (PRES)......Page 105
Metabolic insult causing re-expression of old stroke (MICROS)......Page 106
Bibliography......Page 107
CT: considerations......Page 109
Disadvantages......Page 110
Unenhanced CT......Page 111
CT angiography......Page 118
Infarct detection with CTA-SI......Page 120
CT perfusion......Page 123
Technical considerations......Page 124
CTP radiation dose considerations......Page 125
Acute stroke imaging workflow (Table 7.3)......Page 126
CTP image interpretation pitfalls......Page 132
Unenhanced CT......Page 133
CT venography......Page 134
Bibliography......Page 135
8 Magnetic resonance imaging in acute stroke......Page 140
Technical considerations......Page 141
Conventional T1, T2, and FLAIR images......Page 142
Gradient echo susceptibility-weighted (T2*) imaging......Page 147
Diffusion-weighted MRI......Page 149
Perfusion-weighted MRI......Page 151
Magnetic resonance angiography......Page 152
Bibliography......Page 153
TCD advantages and limitations......Page 155
Fast-track insonation protocol......Page 156
Yield and accuracy of TCD and carotid duplex......Page 159
TCD and carotid duplex criteria for lesions amenable for intervention......Page 161
TCD monitoring of arterial occlusion, reocclusion and recanalization......Page 172
Therapeutic TCD......Page 179
Emboli detection......Page 181
Intracranial stenosis......Page 183
Vasomotor reactivity......Page 184
Right-to-left shunt detection......Page 185
Conclusions......Page 186
References......Page 187
10 Ischemic stroke in the first 24 hours......Page 191
Hospital door to emergency department phase......Page 192
Neurological evaluation......Page 193
Laboratory tests......Page 194
Neuroimaging......Page 203
Vascular imaging......Page 204
IA thrombolysis......Page 205
Mechanical disruption of the clot......Page 206
Management of blood pressure......Page 207
Bibliography......Page 208
Introduction......Page 209
BP management......Page 210
Prevention of DVT and pulmonary embolism......Page 212
Maintenance of normoglycemia......Page 213
Temperature control: normothermia or hypothermia......Page 214
Airway management......Page 216
Weaning parameters......Page 217
Cerebral edema and elevated ICP......Page 218
Nutrition management......Page 219
Prevention of pressure ulcers......Page 220
Early rehabilitation......Page 221
Anticoagulation versus antiplatelet agents......Page 222
Posterior fossa decompression and cerebellectomy......Page 223
Large vessel revascularization......Page 224
Bibliography......Page 226
Risk factors......Page 228
Diagnosis......Page 229
Pathophysiology and hematoma enlargement......Page 230
Outcome and prognostic indicators......Page 235
Airway......Page 236
Blood pressure......Page 237
Hemostatic therapy......Page 238
Patient positioning......Page 240
Fluid resuscitation......Page 242
Fever......Page 243
Surgical management of ICH......Page 244
Bibliography......Page 245
Epidemiology......Page 249
Risk factors for aneurysmal SAH......Page 250
Diagnosis......Page 251
General emergency and critical care management......Page 253
Fluid management......Page 256
Activity progression......Page 257
Glucose management......Page 258
Magnesium......Page 259
Cardiac dysfunction......Page 260
Vasospasm......Page 261
Future therapies......Page 263
Bibliography......Page 264
A basic overview of venous anatomy......Page 266
Signs and symptoms......Page 268
Etiologies......Page 269
Radiologic tests......Page 271
Workup of hypercoagulable state......Page 274
Treatment (Figure 14.4)......Page 275
Prognosis......Page 277
Bibliography......Page 278
Epidemiology......Page 281
Pathophysiology......Page 282
Atrial fibrillation......Page 283
Type of surgery......Page 284
Prediction models......Page 285
Screening the preoperative patient......Page 286
Clopidogrel/ticlopidine......Page 288
Warfarin......Page 289
Postoperative care......Page 290
Bibliography......Page 291
Ischemic strokes are not more common during most of pregnancy, but increase in frequency postpartum......Page 293
Hemostatic, hemodynamic, and hormonal changes during pregnancy contribute to the increased rate of strokes......Page 294
There are several causes of stroke uniquely related to pregnancy......Page 295
Diffusion-weighted imaging is important in preeclampsia and eclampsia......Page 296
Support through controlling blood pressure. Cure by delivery......Page 297
Postpartum cerebral angiopathy is a rare cause of pregnancy-related stroke......Page 298
Air or amniotic fluid embolization can cause systemic collapse and death in addition to focal neurologic deficits......Page 299
The management of peripartum cardiomyopathy is primarily supportive......Page 300
Infarction of the pituitary is a rare complication of pregnancy......Page 301
There are some concerns regarding the appropriate diagnostic modalities to utilize in a pregnant woman......Page 302
There is no consensus on which antithrombotic to use for stroke prophylaxis during pregnancy......Page 303
For other pregnant patients with history of stroke, a balance needs to be found between the risks and inconvenience of anticoagulation and the risks of aspirin exposure to the fetus......Page 304
Conclusions......Page 305
Bibliography......Page 306
Presentation......Page 309
Urgent assessment......Page 310
Neuroimaging......Page 311
Acute management......Page 312
Role of drugs in acute treatment......Page 313
Thrombolysis......Page 314
Warfarin......Page 315
Antiplatelet agents......Page 316
Risk factors and etiologies in childhood stroke......Page 317
Recurrence......Page 320
Medication......Page 322
Hyperhomocysteinemia......Page 323
Outcome......Page 324
Bibliography......Page 325
Thrombosis and antithrombotic drug targets......Page 329
Aspirin......Page 330
Cilostazol......Page 333
Clopidogrel......Page 334
Resistance and treatment failure......Page 335
Anticoagulant therapy......Page 336
Vitamin K antagonists (warfarin)......Page 337
Dabigatran......Page 338
Bibliography......Page 340
Intra-arterial thrombolysis......Page 343
Patient selection......Page 344
Post-procedural management and complications......Page 345
Carotid endarterectomy (CEA)......Page 346
Carotid artery angioplasty and stenting (CAS)......Page 347
Extracranial carotid artery occlusion......Page 348
Intracranial stenosis......Page 349
Posthemorrhagic cerebral artery vasospasm......Page 351
Bibliography and references......Page 352
Introduction......Page 356
Hypertension......Page 357
Treatment recommendations......Page 358
Dyslipidemia......Page 359
Treatment recommendations......Page 360
Atrial fibrillation......Page 361
Treatment recommendations......Page 362
Diabetes mellitus......Page 363
Cigarette smoking......Page 364
Hyperhomocysteinemia......Page 365
Alcohol consumption......Page 366
Diet, obesity, and physical inactivity......Page 367
Conclusion......Page 368
Bibliography......Page 369
NINDS tPA Stroke Trial (NINDS-tPA)......Page 371
ECASS-III: Placebo controlled trial of alteplase (rt-PA) in acute ischemic hemispheric stroke where thrombolysis is initiated between 3 and 4 hours after stroke onset (ECASS-III)......Page 372
Interventional Management of Stroke Study (IMS II)......Page 373
Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke (MERCI)......Page 374
Study to assess the safety and effectiveness of the Penumbra System (PENUMBRA)......Page 375
Asymptomatic Carotid Surgery Trial (ACST)......Page 376
European Carotid Surgery Trial (ECST)......Page 377
Carotid Revascularization Endarterectomy versus Stent Trial (CREST)......Page 378
Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE)......Page 379
Management of Atherothrombosis with Clopidogrel in High-risk patients with recent TIA or ischemic stroke (MATCH)......Page 380
Warfarin-Aspirin Recurrent Stroke Study (WARSS)......Page 381
Warfarin-Aspirin Symptomatic Intracranial Disease Study (WASID)......Page 382
Stroke Prevention in Atrial Fibrillation II (SPAF II)......Page 383
Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE-W)......Page 384
Randomized Evaluation of Long Term Anticoagulant Therapy with Dabigatran Etexilate (RE-LY)......Page 385
Apixaban versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE)......Page 386
MRC/BHF Heart Protection Study (HPS)......Page 387
Heart Outcomes Prevention Evaluation (HOPE)......Page 388
The Anglo-Scandinavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm (ASCOT-BPLA)......Page 389
DEcompressive Craniectomy In MALignant middle cerebral artery infarcts (DECIMAL)......Page 390
DECIMAL, DESTINY, and HAMLET meta-analysis......Page 391
Index......Page 392