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The age-standardized mortality rate for hemorrhagic stroke has decreased worldwide over the past two decades, but incidence, number of deaths, and lost disability-adjusted life-years (DALY) continue to increase. Moreover, hemorrhagic stroke occurs half as frequently globally as ischemic stroke, but causes significantly more deaths and lost DALY. Milestone studies of the past decade - STICH, FAST, and INTERACT2 - indicate the importance of hyperacute care for intracerebral hemorrhage; despite this, there is to date no established strategy for patients analogous to reperfusion therapy for ischemic stroke. This book, written by world-renowned experts, covers all current topics related to the diagnosis and management of intracerebral hemorrhage. It will contribute to an improved understanding of current and future aspects concerning optimal management of patients. This is a comprehensive, up-to-date resource for neurologists, neurosurgeons and trainees.
This volume is focused on subjects related to cerebral ischemia and reperfusion injuries after acute stroke. All chapters are selected from the Sixth Elite Stroke meeting named Pangu Stroke Conference and written by members of world leading laboratories of stroke studies. The contents cover both clinical and bench studies, from basic components of cerebral arterial system to clinical reperfusion injury cases, from reperfusion caused programmed cell death and astrocyte activation to oxidative stress and nitric oxide after reperfusion, from extracellular matrix and inflammation to a role of diabetes after reperfusion, from small artery disorders to collateral circulation and blood pressure control after reperfusion. Wei-Jian Jiang, Chairman of New Era Stroke Care and Research Institute of PLA Rocket Force General Hospital, Beijing, China. Wengui Yu, Professor and Director of Comprehensive Stroke & Cerebrovascular Center, University of California, Irvine Yan Qu, Professor and Director of Neurosurgery at the Second Affiliated Hospital of Air Force Medical University, Xi’an, China. Zhongsong Shi, Professor of Neurosurgery at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. Ben-yan Luo, Professor and Chair of Neurology at the First Affiliated Hospital of Zhejiang University. John H. Zhang, Professor of Anesthesiology and Physiology at Loma Linda University School of Medicine, Loma Linda, CA, USA.
This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.
This book provides a framework for goal-targeted management of the adult patient with spontaneous non-traumatic intracerebral hemorrhage (ICH). Topics addressed in a comprehensive yet practical manner in the book include pre-hospital/emergency department care, early inpatient work-up, antithrombotic- and thrombolytic-related strokes, optimal blood pressure management, avoidance of medical complications, surgical interventions, outcome prognostication, recurrence prevention, rehabilitation/recovery, special situations, systems of care, and the design of clinical trials for patients with ICH. Procedures, processes, and helpful decision-making algorithms are presented with the aid of complementary illustrations that facilitate understanding of practical aspects and enable the reader to promptly retrieve relevant information. In addition, the most current evidence-based therapies for routine management of ICH patients and a glimpse of promising future treatment strategies are reviewed. Timely and consolidated, clinicians will find this to be an indispensable resource to navigating the ever-increasing pace of discovery that is transforming what we know about ICH and its treatment.
During the last decade scientists in both basic and clinical research have renew ed their interest in the potential role of thrombolytic therapy in the treatment of acute ischemic stroke. The reevaluation of this approach was kindled by our growing knowledge of the pathogenesis of thrombotic and embolic stroke and by the development of new thrombolytic agents. With no proven therapy for acute ischemic stroke available, the potential value of early pharmacologic recanalization of occluded vessels in the management of acute stroke patients - an approach that has been supported by animal experiments and a limited number of uncontrolled clinical pilot studies - is again under scrutiny. A sym posium on "Thrombolysis in Acute Cerebral Ischemia" was held in Heidel berg, Germany, in May 1990 to summarize and discuss the pathophysiological background for thrombolysis in acute ischemic stroke and the recent ex perimental and clinical experience with the new generation of thrombolytic agents. The editors are fortunate to be able to include authoritative manuscripts from almost all the speakers at the symposium. These include reports of work by the most active investigators in this challenging field. The editors wish to express their gratitude to all the contributors for the additional work they have undertaken. Additionally, we would like to thank Springer-Verlag, Heidelberg, for its generous assistance in the preparation and rapid publication of this volume. Heidelberg, August 1990 WERNER HACKE GREGORY J. DEL ZopPO MATTHIAS HIRSCHBERG Contents I.
On the threshold of an exciting new era for acute stroke diagnosis and treatment, the Third International Symposium on Thrombolytic Therapy in Acute Ischemic Stroke was held in Nara, Japan, in April 1994. The symposium brought together some 200 basic and clinical scientists for presentations and discussions of issues vital to the understanding of thrombolytic therapy. This volume compiles the major presentations of the symposium, with attention to applications of new diagnostic measures such as diffusion and perfusion MRI, contrast-enhanced transcranial Doppler and angioscopy. Other presentations examine the mechanisms of ischemia/reperfusion injury, hemorrhagic transformation, and reocclusion, with reviews of recent developments in thrombolytic agents. The proceedings of the symposium will be of special interest to researchers, physicians, and students in the fields of neurology, neurosurgery, and nuclear medicine, as well as those in pharmacology, critical care medicine, and related fields.
Background and Purpose: Epidemiological correlations between active malignancy (AM) and acute ischemic stroke are well established. However, the effect of reperfusion strategies, particularly mechanical thrombectomy (MT), has been barely investigated in patients with acute ischemic stroke and AM. We aim to evaluate safety and efficacy of reperfusion strategies in such patients.Materials and Methods: we performed a case-control analysis comparing patients with AM and acute ischemic stroke (AM group) to a group of cancer-free patients with acute ischemic stroke (control group). All enrolled patients underwent reperfusion therapies (i.e. intravenous thrombolysis, mechanical thrombectomy, intravenous thrombolysis plus mechanical thrombectomy). Main outcomes were 3-month functional independence, successful reperfusion, 3-month mortality, symptomatic intracranial hemorrhage.Results: 24 patients with AM and acute ischemic stroke (mean age: 69u00b110.1) were individually matched to 24 control patients (mean age: 70.7u00b19.3). In both groups 50% were treated with mechanical thrombectomy, 46% with intravenous thrombolysis and 4% with intravenous thrombolysis plus mechanical thrombectomy. No difference were found in successful reperfusion, 3-month functional independence, symptomatic intracranial hemorrhage and mortality. However an overall mortality of 33% in the AM group was reported.Conclusions: Reperfusion strategies for acute ischemic stroke patients with AM seem to be safe and effective. However an individualized approach to understand cancer stage and life-expectation is warranted.
This book provides detailed practical guidance on the management of acute ischemic stroke in the clinical settings encountered in daily practice. Real-life cases are used to depict a wide range of clinical scenarios and to highlight significant aspects of management of ischemic stroke. In addition, diagnostic and therapeutic protocols are presented and helpful decision-making algorithms are provided that are specific to the different professionals involved in delivery of acute stroke care and to differing types of hospital facility. The coverage is completed by the inclusion of up-to-date scientific background information relevant to diagnosis and therapy. Throughout, the approach adopted is both practical and multidisciplinary. The book will be of value for all practitioners involved in the provision of acute stroke care, and also for medical students.