Ji Y. Chong

Cerebrovascular Disease (eBook, PDF)

• Format: PDF

Produktbeschreibung

Patients suffering from cerebrovascular disease pose many clinical challenges and even experienced clinicians can arrive at the point where diagnostic, work-up, treatment, or prognostic thinking falters. Authored by a vascular neurologist whose work spans the entire spectrum of this group of brain dysfunctions, Cerebrovascular Disease helps clinicians evaluate and manage patients suffering from stroke, embolism, thrombosis, hemorrhage, and other critical presentations. In a medical field where it's often difficult to distill the vast array of research and apply it in any meaningful clinical way, this next volume in the "What Do I Do Now?" series focuses on walking the clinician through evidence-based decision-making. Each clinical scenario featured in Cerebrovascular Disease describes in careful detail the presentation, diagnostic studies, treatment options, and rationale for handling these tricky cases.

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Produktdetails

• Verlag: Oxford University Press
• Seitenzahl: 160
• Erscheinungstermin: 1. Mai 2013
• Englisch
• ISBN-13: 9780199325306
• Artikelnr.: 40340647

Autorenporträt

Attending in Neurology and Director, Stroke Prevention Program, St. Luke's Roosevelt Hospital Center. Assistant Clinical Professor of Neurology, Columbia University.

Inhaltsangabe

* Table of Contents
* Case 1 IV tPA for acute ischemic stroke
* IV tPA is the only FDA approved treatment for acute ischemic stroke.
It needs to be delivered in a timely fashion, but select patients may
be treated beyond the 3 hour window out to 4 and a half hours.
* Case 2 Endovascular treatment for acute ischemic stroke
* Select patients who are not eligible for IV tPA and are within an 8
hour window may be treated with other acute endovascular therapies.
* Case 3 Combination reperfusion therapy for acute stroke
* In patients who do not recanalize with IV tPA, adjunctive
endovascular therapies may be used to improve reperfusion.
* Case 4 Hemorrhagic complications of tPA
* Intracerebral hemorrhage is a known complication of tPA. Different
hemostatic agents can be used for symptomatic hemorrhage.
* Case 5 Stroke mimic and acute treatment
* Patients with stroke mimics and eligible for tPA may safely be
treated. The diagnosis of a stroke mimic is typically made after the
acute setting.
* Case 6 Minor stroke symptoms and acute treatment
* Patients with minor stroke symptoms or rapid improvement of symptoms
are at high risk of worsening. Acute treatment with IV tPA may be
warranted.
* Case 7 Hemicraniectomy for large MCA stroke
* Malignant MCA syndromes have high morbidity and mortality.
Hemicraniectomy in select patients is life saving but patients often
have significant disability.
* Case 8 Suboccipital decompression for cerebellar stroke
* Large cerebellar strokes can cause rapid neurological deterioration
and death. Surgical decompression is an effective, life saving
treatment.
* Case 9 Blood pressure management in acute stroke
* Blood pressure is commonly elevated after a stroke. Early lowering of
blood pressure may worsen outcomes.
* Case 10 Primary prevention of stroke
* Screening for risk factors and treatment of modifiable risk factors
will lower the risk of incident stroke.
* Case 11 Asymptomatic carotid stenosis
* Revascularization of high grade asymptomatic carotid stenosis in
select patients can lower the risk of incident stroke. Endarterectomy
and stenting are both associated with periprocedural risk.
* Case 12 Secondary stroke prevention after lacunar stroke
* Long term blood pressure management is important after lacunar
stroke. Antiplatelet therapy should be instituted for secondary
stroke prevention.
* Case 13 Secondary stroke prevention after stroke due to carotid
stenosis
* Patients with symptomatic carotid stenosis benefit from
revascularization. Carotid endarterectomy and carotid stenting are
options for treatment.
* Case 14 Secondary stroke prevention after stroke due to intracranial
atherosclerosis
* Medical therapy with antiplatelet therapy and aggressive risk factor
control is the preferred treatment regimen for stroke prevention in
patients with intracranial atherosclerosis.
* Case 15 Secondary stroke prevention after cardioembolic stroke
* Anticoagulation significantly lowers recurrent stroke risk in
patients with atrial fibrillation. New oral anticoagulants offer
options in addition to warfarin.
* Case 16 Secondary stroke prevention after cryptogenic stroke with PFO
* Medical therapy for patients with stroke and PFO include antiplatelet
therapy or anticoagulation. PFO closure is not routinely recommended
for stroke prevention.
* Case 17 Carotid dissecton
* Carotid dissection can be recognized by exam findings and
radiographic studies. Treatment can include aspirin or
anticoagulation.
* Case 18 Stroke in a young adult
* Traditional vascular risk factors can contribute to stroke in young
adults. Other more unusual causes of stroke should be considered
based on the clinical setting.
* Case 19 Mycotic aneurysm due to bacterial endocarditis
* Bacterial endocarditis can cause neurological complications including
stroke, hemorrhage, and mycotic aneurysms.
* Case 20 Migrainous stroke
* Stroke can rarely occur in the setting of acute migraine. Other
etiologies of stroke need to be investigated
* Case 21 Dural venous sinus thrombosis
* Intracranial venous thrombosis is a rare cause of stroke.
Investigation for underlying prothrombotic state is needed. Treatment
is typically with anticoagulation.
* Case 22 Moyamoya disease
* Moyamoya is a rare cause of stroke. Surgical intervention may reduce
the risk of recurrent stroke.
* Case 23 Reversible cerebral vasoconstriction syndrome
* Reversible cerebral vasoconstriction syndrome can cause thunderclap
headache, subarachnoid hemorrhage, and stroke. Angiographic findings
of vasculopathy and resolution support this diagnosis.
* Case 24 TIA diagnosis and management
* TIA is a risk factor for subsequent stroke. Rapid evaluation and
treatment reduce that risk.
* Case 25 Hypertensive ICH
* Hemorrhage due to hypertension usually occurs in subcortical
locations. Prevention involves aggressive blood pressure control.
* Case 26 Cerebral amyloid angiopathy
* Cerebral amyloid angiopathy is more prevalent with advancing age.
Recurrent lobar hemorrhage and white matter disease may be seen.
* Case 27 Intracerebral hemorrhage secondary to AVM
* AVMs may cause intracerebral hemorrhage. Treatment can be challenging
and multimodal treatment is often required
* Case 28 Cavernous malformation
* Cavernous malformations may cause intracerebral hemorrhage and
seizures. Surgical resection is considered in patients with
accessible lesions and recurrent hemorrhage or refractory seizures.
* Case 29 Aneurysmal subarachnoid hemorrhage
* Diagnosis is made by CT scan in most cases, but lumbar puncture may
be needed if CT findings are normal. Rapid evaluation and treatment
are important because of the high morbidity and mortality.
* Case 30 Perimesencephalic SAH
* Perimesencephalic SAH is a more benign subset of SAH. Evaluation for
aneurysm is obligatory.
* Case 31 Asymptomatic intracranial aneurysm
* Location and size of an intracranial aneurysm are helpful in
stratifying risk of hemorrhage. Treatment may be observation,
surgical clipping, or endovascular coiling.