The stroke book / edited by Michel T. Torbey, Magdy H. Selim.

Format:

Book

Contributor:

Torbey, Michel T., editor.

Selim, Magdy H., editor.

Language:

English

Subjects (All):

Cerebrovascular disease--Diagnosis.

Cerebrovascular disease.

Cerebrovascular disease--Treatment.

Physical Description:

1 online resource (xiii, 380 pages) : digital, PDF file(s).

Edition:

Second edition.

Place of Publication:

Cambridge : Cambridge University Press, 2013.

Summary:

Designed for use by busy professionals who need quick answers, this revised and updated second edition of The Stroke Book is a concise and practical reference for anyone involved in managing critically ill cerebrovascular patients. • Covers a wide range of common conditions such as ischemic and hemorrhagic strokes, subarachnoid hemorrhages and intracranial aneurysms • Provides focused protocols for assessing and treating stroke patients in the emergency room, intensive care unit or general hospital setting • A new chapter summarizes key clinical trials for stroke therapies • User-friendly format • Packed with algorithms, tables and summary boxes for immediate access to key information • A color plate section illustrates key pathology and diagnostic imaging Written by experienced contributors from leading stroke centers, this is an essential companion for navigating stroke-related clinical situations successfully and making informed decisions about treatment.

Contents:

Intro

Contents

List of contributors

Foreword

Introduction

Section I Assessment of Stroke Patients

1 Emergency medical services (EMS): first line of defense against stroke

The golden hour

EMS pre-hospital assessment

Pre-hospital stroke assessment instruments

The Los Angeles pre-hospital stroke screen (LAPSS)

The Cincinnati pre-hospital stroke scale (CPSS)

The Newcastle face arm speech test (FAST)

Speech

Facial movements

Arm movements

Melbourne ambulance stroke screen (MASS)

Miami emergency neurological deficit (MEND)

Central Ohio trauma system (COTS)

Regional EMS/hospital stroke alert tool

EMS pre-hospital management of the acute stroke patient

EMS communication with receiving emergency departments

Determining the stroke patient´s destination

Primary stroke center (PSC)

Comprehensive stroke center (CSC)

Summary

Bibliography

2 Initial assessment of patients with stroke-like symptoms

General medical examination

General health and appearance

Vital signs

Fundoscopic examination

Carotid/vertebral artery examination

Cardiac examination

Dermatological examination

Neurological examination

Mental status

Alert

Orientation

Attention

Memory

Language

Calculation

Neglects

Apraxias

Frontal lobe dysfunction

Cranial nerves

I

Olfactory

II

Optic

III, Oculomotor

IV, Trochlear

VI, Abducens

V, Trigeminal

VII, Facial

VIII, Auditory/vestibular

IX, Glossopharyngeal

X, Vagus complex

IX, Spinal accessory

XII, Hypoglossal

Motor

Bulk and tone

Drift

Strength

Coordination

Rapid alternating movements

Finger to nose

Heel to shin

Rebound/overshoot/mirror test

Sensation

Fine touch

Extinction

Pin prick/temperature

Vibration

Proprioception.

Cortical sensory loss

Romberg test

Gait

Description

Reflexes/Toes

NIH stroke scale (NIHSS)

Stroke imitators

OCSP classification

Seizures

Toxic/metabolic encephalopathy

Space-occupying lesions

Syncope

Vestibular dysfunction

Migraine

Spinal cord lesion

3 Clinical stroke syndromes and localization

Syndromes

Ischemic syndromes

Lacunar (penetrating artery)

Embolic

Atherosclerotic

Hemorrhagic syndromes

Location (radiologic syndromes)

Localization

General pearls

Anterior circulation

Internal carotid artery (ICA)

Retinal ischemia

Hemispheric ischemia

Dissection

Middle cerebral artery (MCA)

Main stem

Penetrating artery

Superior division

Inferior division

Anterior cerebral artery (ACA)

Anterior choroidal artery

Borderzone

Posterior circulation

Anterior spinal artery

Medial medullary

Vertebral artery

(Extracranial) dissection

Lateral medullary (Wallenberg)

Posterior inferior cerebellar artery (PICA)

Basilar artery

Proximal stem

Anterior inferior cerebellar artery (AICA)

Superior cerebellar artery (SCA)

Top of the basilar

Posterior cerebral artery (PCA)

Proximal

Distal

Bilateral PCA

Notable variations

Fetal PCA

Azygos ACA origin

Atresia of the AComm (anterior communicating artery)

Azygos paramedian artery (Percheron)

PICA terminus to vertebral artery

Section II The Hunt for a Stroke Etiology

4 The hunt for a stroke etiology: ischemic stroke

History and physical examination

Initial diagnostics

The pipes: investigation of craniocervical arteries

Steno-occlusive etiologies

Atherosclerotic plaque

Arterial dissection

Vasculopathies

Vasculitides

Cerebral vasospasm.

The pump: investingation of the heart

Cardiac embolism

Left ventricular thrombus

Left atrial thrombus

Valvular disease

Interseptal cardiac defect/shunt

Arrhythmia

Cardiomyopathy with congestive heart failure (CHF)

Other infections of the heart

Aortic disease

Intracardiac tumors

The blood: hypercoagulable, hypercellular, and prothrombotic states

Hereditary thrombophilia

Aquired thrombophilia

Blood cell disorders

Polycythemia vera

Diagnosis

Essential thrombocythemia

Sickle cell disease

Hereditary spherocytosis

Other causes of ischemic stroke

Fabry disease

MELAS

5 The hunt for a stroke etiology: hemorrhagic stroke

History and clinical examination

Laboratory tests

Imaging

Computed tomography

Magnetic resonance imaging

CT and MR angiography

Cerebral angiography

Histopathology

Cerebrospinal fluid analysis

General protocol

Conclusion

6 Uncommon causes of stroke and stroke mimics

Vasculitis

Primary angiitis of the CNS

Temporal arteritis

Behcet's disease

Other vasculitides

Connective tissue disorders

Systemic lupus erythematosus (SLE)

Marfan syndrome

Ehlers-Danlos syndrome

Fibromuscular dysplasia (FMD)

Angiopathies

Moyamoya syndrome

Susac's syndrome

Hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS)

Osler-Weber-Rendu disease

Arterial dissections

Sneddon's syndrome

Metabolic diseases

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Fabry's disease

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)

Homocystinuria

Hematologic and oncologic causes.

Hyperviscosity syndromes

Strokes in the setting of cancer

Substance abuse

Infections

Bacterial infections

Viral infections

Fungal infections

Parasitic infections

Migrainous infarction

Stroke mimics

Intracranial mass lesion

Subdural hematoma

Alternating hemiplegia

Posterior reversible encephalopathy syndrome (PRES)

Hypoglycemia

Non-ketotic hyperglycemia

Radial neuropathy

Metabolic insult causing re-expression of old stroke (MICROS)

Conversion disorder

Malingering

Section III Acute Stroke Imaging

7 Computed tomography in acute stroke

CT: considerations

Advantages and disadvantages of CT

Advantages

Disadvantages

Unenhanced CT

CT angiography

Infarct detection with CTA-SI

CT perfusion

Technical considerations

CTP radiation dose considerations

Clinical role of CTP

Acute stroke imaging workflow (Table 7.3)

Potential future applications of CTP: extending the ``treatment time window´´

CTP image interpretation pitfalls

CTP imaging predictors of clinical outcome

Cerebral venous infarcts and CT venography

Enhanced CT

CT venography

Summing up: important considerations in acute stroke imaging

Conclusions

8 Magnetic resonance imaging in acute stroke

Pathophysiological principles of MRI

Clinical applications of MRI in stroke patients

Conventional T1, T2, and FLAIR images

Gradient echo susceptibility-weighted (T2*) imaging

Diffusion-perfusion MRI and the ischemic penumbra

Diffusion-weighted MRI

Perfusion-weighted MRI

Magnetic resonance angiography

Special considerations

9 Neurosonology in acute ischemic stroke

TCD advantages and limitations

Fast-track insonation protocol.

Yield and accuracy of TCD and carotid duplex

TCD and carotid duplex criteria for lesions amenable for intervention

TCD monitoring of arterial occlusion, reocclusion and recanalization

Therapeutic TCD

Other bedside diagnostic applications

Emboli detection

Intracranial stenosis

Vasomotor reactivity

Right-to-left shunt detection

Evaluating collateral circulation by TCD

References

Section IV Management of Stroke Patients

10 Ischemic stroke in the first 24 hours

Hospital door to emergency department phase

Neurological evaluation

Confirming the diagnosis of stroke

Neuroimaging

CT versus MRI in evaluation of hyperacute stroke

Vascular imaging

Acute treatment(s) for ischemic stroke in the first 24 hours

IV thrombolysis (rt-PA)

IA thrombolysis

IV/IA combination therapy

Mechanical disruption of the clot

Management of hydration and fluid status

Management of fever

Management of blood sugar

Management of blood pressure

11 Management of the acute ischemic stroke patient beyond 24 hours

Stroke centers and acute stroke units

Neurointensive care unit

BP management

Hypotension and hydration

Prevention of DVT and pulmonary embolism

Maintenance of normoglycemia

Temperature control: normothermia or hypothermia

Airway management

Weaning parameters

Cerebral edema and elevated ICP

Nutrition management

Prevention of pressure ulcers

Prevention of UTIs

Early post-stroke seizures

Early rehabilitation

Early antithrombotics

Anticoagulation versus antiplatelet agents

Early statin use

Surgical and endovascular management

Decompressive hemicraniectomy

Posterior fossa decompression and cerebellectomy

Ventricular drainage.

Evacuation of intracerebral hemorrhage.

Notes:

Title from publisher's bibliographic system (viewed on 05 Oct 2015).

Includes bibliographical references and index.

ISBN:

1-107-27280-7

1-107-27747-7

1-107-42296-5

1-107-27870-8

1-107-27545-8

1-107-27421-4

1-139-34429-3

OCLC:

852158503