Stroke
Section Title Stroke Practical Guide for Clinicians Editor Natan M. Bornstein Tel Aviv 18 figures, 4 in color, and 35 tables, 2009 Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney
Natan M. Bornstein Tel Aviv Sourasky Medical Center Tel Aviv, Israel Library of Congress Cataloging-in-Publication Data Stroke : practical guide for clinicians / editor, Natan M. Bornstein. p. ; cm. Includes bibliographical references and indexes. ISBN 978 3 8055 9099 0 (hard cover : alk. paper) 1. Cerebrovascular disease. I. Bornstein, Natan M. [DNLM: 1. Stroke physiopathology. 2. Stroke diagnosis. 3. Stroke therapy. WL 355 S9213432 2009] RC388.5.S85285 2009 616.8'1 dc22 2009005231 Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2009 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISBN 978 3 8055 9099 0 e-isbn 978 3 8055 9100 3
Section Title Contents VII IX List of Contributors Preface Bornstein, N.M. (Tel Aviv) Introduction 1 Anatomy and Pathophysiology of Stroke Auriel, E. (Tel Aviv) Burden of Stroke 9 Burden of Stroke and Risk Factors Gorelick, P.B. (Chicago) Pathophysiology of Ischemia 24 Implications of Stroke Pathophysiology and the Ischemic Penumbra Fisher, M. ; Kumar, R. (Worcester, Mass.) Neuroplasticity and Neurorecovery 37 Neuroplasticity and Neurorecovery Muresanu, D.F. (Cluj-Napoca) Classification of Stroke Subtypes 50 Classification of Stroke Subtypes Norrving, B. (Lund) Imaging in Stroke- Diagnosis and Prevention 64 Neuroimaging von Kummer, R. (Dresden) 75 Use of Ultrasound in Acute Ischemic Stroke Csiba, L. (Debrecen) V
How to organize Stroke Care? 93 Stroke Units Brainin, M.; Tatschl, C.; Teuschl, Y. (Krems) Management of Acute Stroke 105 Management of Acute Ischemic Stroke The HYPER-Link-Hypertension, Hyperglycemia and Hyperthermia Auriel, E.; Bornstein, N.M. (Tel Aviv) 113 Management of Acute Stroke: Thrombolytic Therapy Wahlgren, N. (Stockholm) 128 Management of Acute Stroke: Neuroprotection Muresanu, D.F. (Cluj-Napoca) Post-Stroke Complications 137 Late Post Stroke Complications Auriel, E.; Bornstein, N.M. (Tel Aviv) Secondary Stroke Prevention 144 Secondary Stroke Prevention Medical Treatment Weber, R.; Diener, H.C. (Duisburg/Essen) 160 Surgical and Endovascular Interventions for the Secondary Prevention of Stroke Rothwell, P.M. (Oxford) Intracranial Hemorrhage 174 Intracerebral Hemorrhage Chemmanam, T.; Davis, S. (Melbourne) 196 Author Index 197 Subject Index VI Contents
Section Title List of Contributors Dr. Eitan Auriel Tel Aviv Sourasky Medical Center 6 Weitzman Street Tel Aviv, Israel Prof. Natan M. Bornstein Tel Aviv Sourasky Medical Center 6 Weitzman Street Tel Aviv, Israel Professor Michael Brainin Donau-Universität Krems Neurologie-Abteilung, Donauklinikum Dorrelstr. 30 Krems, Austria Dr. Thomas Chemmanam 47 Wetherby Road Doncaster, Australia Professor László Csiba Debrecen University Móricz Zs. 22 Debrecen, Hungary Professor Stephen Davis Royal Melbourne Hospital University of Melbourne Grattan Street Parkville, Australia Professor Hans-Christoph Diener University Duisburg-Essen Hufelandstrasse 55 Essen, Germany Dr. Marc Fisher UMASS/ Memorial Healthcare Worcester, Mass. Dr. Philip B. Gorelick and Rehabilitation 912 S. Wood Street Room 855 N Chicago, Ill. Dr. Rajat Kumar UMASS/ Memoriral Healthcare 55 Lake Avenue North Worcester, Mass. Professor Dafin F. Muresanu, Dean, Faculty of Health Sciences University of Medicine and Pharmacy Iuliu Hatieganu 8 Victor Babes Cluj-Napoca, Romania Professor Bo Norrving Lund University Hospital Lund, Sweden VII
Professor Peter M. Rothwell University Department of Clinical Neurology Stroke Prevention Research Unit Level 6, West Wing John Radcliffe Hospital, Headington Oxford, United Kingdom Dr. Claudia Tatschl Landesklinikum Tulln Alter Ziegelweg 10 Tulln, Austria Dr. Yvonne Teuschl Donau-Universität Krems Neurologie-Abteilung, Donauklinikum Dorrelstr. 30 Krems, Austria Professor Rüdiger von Kummer Department of Neuroradiology Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden Fetscherstr. 74 Dresden, Germany Professor Nils Wahlgren Karolinska University Hospital Building R2:03 Stockholm, Sweden Dr. Ralph Weber University Duisburg-Essen Hufelandstrasse 55 Essen, Germany VIII List of Contributors
Preface Stroke is the second leading cause of death and the major cause of long-term, physical, emotional and social disability in the elderly around the world, affecting 0.2% of the entire population. Stroke: is a preventable and treatable catastrophe was the motto of the World Stroke Day proclamation, 2006. Knowing and treating the most common risk factors for stroke such as hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and obesity may reduce the occurrence of stroke substantially. Awareness is the first step towards action. Unfortunately, the public and physician awareness about stroke and its major contributors is not high enough and therefore the risk factors are not well treated or controlled. In the last decades, there has been tremendous progress in the development of noninvasive diagnostic techniques like ultrasound MRI, CT angiography, CT perfusion, etc., as well as new effective therapeutic strategies for acute ischemic stroke which established vascular neurology as one of the most progressive fields in medicine. The intention of this book is to bring together the most recent updated advanced knowledge on the practical clinical approach to stroke medicine, and covers essential and practical information on the pathophysiology and epidemiology of stroke, new diagnostic techniques which allow for better diagnosis and identification of various subtypes of stroke, and new therapeutic strategies for acute stroke and transient ischemic attack. Natan M. Bornstein, Tel Aviv IX