Acute Stroke: Bench to Bedside

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ISBN: 9780849398704 | 0849398703
Cover: Hardcover
Copyright: 9/18/2006

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As the third leading cause of death in the United States, stroke accounts for one in every fifteen deaths and is the major cause of disability in the country. Compiled by a renowned editorial team, this reference bridges the gap between basic science and patient care protocols, and collects 43 expertly written chapters that range from laboratory-based research on animal models to the progression, mechanisms, treatment, and prognosis of diseases such as subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), focal ischemic stroke, and global cerebral ischemia.

Foreword

Myron D. Ginsberg

Preface

vii

Contributors

xix

Section I. Subarachnoid Hemorrhage

Animal Models of Subarachnoid Hemorrhage

(14)

Gustavo Pradilla

Quoc-Anh Thai

Rafael J. Tamargo

Introduction

(1)

In Vitro Models of Vasospasm

(1)

In Vivo Models of Vasospasm

(1)

Creation of SAH and Induction of Vasospasm

(1)

Monkey Models

(1)

Rabbit Models

(1)

Dog Models

(1)

Cat Models

(1)

Rat Models

(1)

Mouse Models

(1)

Other Models

(1)

Conclusions

(1)

References

(6)

Pathogenesis of Cerebral Aneurysm Growth and Rupture

(14)

Wesley Hsu

Richard E. Clatterbuck

Introduction

(1)

Histology

(1)

Pathology

(1)

Theories of Saccular Aneurysm Etiology

(1)

Connective Tissue Disorders and Aneurysmal Formation

(1)

Familial Aneurysmal Formation

(1)

Mechanical Factors in Aneurysmal Formation

(2)

Hypertension

(1)

Vessel Wall Homeostasis and Aneurysmal Formation

(1)

Traumatic Intracranial Aneurysms

(1)

Infectious Aneurysm

(1)

Conclusions

(1)

References

(5)

Pathogenesis of Cerebral Vasospasm

(16)

Frederick W. Lombard

Cecil O. Borel

Introduction

(1)

Etiology of Vasospasm

(2)

Endothelial Dysfunction

(5)

Vascular Remodeling Following SAH

(1)

Cerebral Blood Flow

(1)

Conclusions and Future Directions

(1)

References

(6)

Surgical Management of Aneurysmal Subarachnoid Hemorrhage

(8)

Quoc-Anh Thai

Gustavo Pradilla

Daniele Rigamonti

Introduction

(1)

Clinical Presentation of aSAH

(1)

Diagnosis of Subarachnoid Hemorrhage and Aneurysms

(2)

Grading and Prognosis of aSAH

(1)

Complications After aSAH

(1)

Surgical Intervention

(2)

Conclusion

(1)

References

(3)

Endovascular Management of a Patient After Subarachnoid Hemorrhage

(14)

Stephen Chang

Abhishek Srinivas

Kieran Murphy

Introduction

(1)

Team- and Consensus-Based Approach to Aneurysm Care

(1)

Endovascular Management Following aSAH

(1)

Coiling

(1)

Developments

(1)

Skill Acquisition

(1)

Stent Assistance

(1)

Balloon Assistance

(1)

Matrix or PGA/PGLA Coatings on Coils

(1)

Detachment Systems

(1)

CAP and Onyx for Aneurysmal Filling

(1)

Vessel Occlusion as a Method of Treating Aneurysms

(1)

BTO and Preprocedure ECIC Bypass

(1)

Vertebral Dissecting Aneurysms

(1)

Vasospasm After aSAH

(1)

GDC Coiling and Intraventricular rtPA After Aneurysm

(1)

Intraoperative Angiography and Outcome of Clip Position in the Operating Room

(1)

Postcoil Follow-Up---Coil Compression and Recanalization

(1)

New Aneurysms and the Need for Follow-Up

(1)

Acute vs. Chronic Aneurysms (Cocaine-Related Bleed Sites)

(1)

Our Philosophy on Aneurysms

(1)

References

(6)

Intraoperative Management of Aneurysmal Subarachnoidal Hemorrhage

(14)

Ansgar M. Brambrink

Jeffrey R. Kirsch

Introduction

(1)

Routine Intraoperative Management

(6)

Special Problems and Techniques

(3)

Conclusion

(1)

References

(5)

Medical Management of Subarachnoid Hemorrhage

(12)

Yekaterina K. Axelrod

Michael N. Diringer

Presentation

(1)

Evaluation and Initial Management

(3)

Early Critical Care Management

(2)

Late Complications

(3)

Conclusion

(1)

References

(4)

Clinical Trials in Subarachnoid Hemorrhage

(10)

Nader Pouratian

Aaron S. Dumant

Thomas P. Bleck

Introduction

(1)

Prevention of Rebleeding

(2)

Prevention and Treatment of Vasospasm

(3)

Neuroprotection

(1)

Why Have Previous Clinical Trials in Aneurysmal Subarachnoid Hemorrhage Failed?

(1)

Conclusion and Future Directions

(1)

References

100

(3)

Prognosis and Outcomes Following Aneurysmal Subarachnoid Hemorrhage

103

(8)

Richard E. Temes

J. Michael Schmidt

Stephan A. Mayer

Introduction

103

(1)

Clinical Grading Scales

103

(1)

Delayed Cerebral Ischemia

103

(1)

Hierarchy of Clinical and Functional Outcomes After aSAH

104

(1)

Global Outcome Scales

105

(1)

Neurologic Impairment After aSAH

105

(2)

Disability and Handicap After aSAH

107

(1)

Quality of Life After aSAH

108

(1)

Conclusions and Future Directions

108

(1)

References

109

(2)

Section II. Intracerebral Hemorrhage

Animal Models of Intracerebral Hemorrhage

111

(12)

Kenneth R. Wagner

Thomas G. Brott

Introduction

111

(1)

Models and Species: Overview

111

(1)

Intracerebral Blood Infusion ICH Models

112

(3)

Bacterial Collagenase Model

115

(1)

Ischemia-Reperfusion Hemorrhage Model

116

(1)

Brain Pathologic Response to ICH in Animal Models

116

(1)

Limitations of Animal Models

117

(1)

Summary of Animal Species and ICH Induction Methods

117

(1)

Overall Summary and Conclusions

118

(1)

References

118

(5)

Pathophysiologic Mechanisms of Brain Injury Following Intracerebral Hemorrhage

123

(10)

Gustavo J. Rodriguez

Jawad F. Kirmani

Mustapha A. Ezzeddine

Adnan I. Qureshi

Introduction

123

(1)

Pathology of Hematoma and Mechanical Compression

123

(1)

Pathology of the Perihematoma Region

124

(1)

Role of Cerebral Blood Flow Changes

124

(2)

Role of Thrombin and Blood Products

126

(1)

Role of Inflammation and Glutamate

127

(1)

Role of Matrix Metalloproteinases

127

(1)

Conclusions and Future Directions

127

(1)

References

128

(5)

Surgical Management of Intracerebral Hemorrhage

133

(8)

Gavin W. Britz

Arthur M. Lam

Introduction

133

(1)

Etiologic Factors for Intracerebral Hemorrhage

133

(1)

Pathophysiology

133

(1)

Diagnosis of Intracerebral Hemorrhage

134

(1)

Surgical vs. Medical Management

134

(2)

Clinical Trials

136

(1)

Indications for Surgical Therapy

136

(1)

Anesthetic Considerations

137

(1)

Surgical Techniques

137

(1)

Conclusions

138

(1)

References

138

(3)

Medical Management of Intracerebral Hemorrhage

141

(10)

Neeraj S. Naval

J. Ricardo Carhuapoma

Introduction

141

(1)

Diagnosis

141

(1)

Early Management

142

(2)

Coagulopathies

144

(1)

Activated Recombinant Factor VIIA

144

(1)

Intraventricular Thrombolysis

145

(1)

Surgical Treatment and ICH Thrombolysis

145

(1)

Increased Intracranial Pressure and Cerebral Edema

146

(1)

Seizures

146

(1)

Treatment of Precipitating Factors

147

(1)

Other General Medical Aspects

147

(1)

Conclusion

148

(1)

References

148

(3)

Clinical Trials in Intracerebral Hemorrhage

151

(10)

Alejandro A. Rabinstein

Eelco F. M. Wijdicks

Introduction

151

(1)

Surgical Evacuation

151

(4)

Medical Treatment

155

(3)

Future Trials

158

(1)

References

159

(2)

Prognosis and Outcomes Following Intracerebral Hemorrhage

161

(10)

Stanley Tuhrim

Introduction

161

(1)

Prognosis by Specific Lesion Site

161

(1)

General Prognostic Features

162

(1)

Long-Term Prognosis

163

(2)

Specific Prognostic Features

165

(2)

Conclusion

167

(1)

References

167

(4)

Section III. Focal Ischemic Stroke

Animal Models of Ischemic Stroke

171

(16)

Turgut Tatlisumak

Fuhai Li

Marc Fisher

Introduction

171

(1)

Animal Selection

171

(1)

Approaches for Inducing Focal Cerebral Ischemia

172

(6)

Monitoring

178

(1)

Outcome Measures

179

(2)

Conclusions

181

(1)

References

181

(6)

Pathogenesis of Brain Injury Following Ischemic Stroke

187

(18)

Xian Nan Tang

Zhen Zheng

Midori A. Yenari

Introduction

187

(1)

Excitotoxicity, Intracellular Calcium, and Ischemic Brain Injury

187

(3)

Oxidative Stress and Brain Ischemia

190

(3)

Ischemia-Induced Gene Expression

193

(1)

Apoptosis

194

(2)

Inflammation Following Cerebral Ischemia

196

(2)

Matrix Metalloproteinases

198

(1)

Conclusions and Future Directions

199

(1)

References

199

(6)

Neuroimaging in Ischemic Stroke

205

(12)

Jose G. Merino

Steven Warach

Introduction

205

(1)

MRI in Clinical Care

205

(3)

MRI in Stroke Research

208

(4)

References

212

(5)

Thrombolytic Therapy for Acute Ischemic Stroke

217

(12)

Christopher V. Fanale

Patrick D. Lyden

Introduction

217

(1)

Early Clinical Considerations

217

(2)

Intravenous Thrombolytics in Acute Stroke Therapy

219

(3)

Intra-arterial Thrombolytics in Acute Stroke Therapy

222

(2)

Other Thrombolytics for Acute Stroke

224

(1)

Emerging Technologies

224

(1)

Controversies in the Use Intravenous rtPA

225

(1)

Stroke Centers

226

(1)

References

226

(3)

Medical Management of Acute Ischemic Stroke

229

(14)

Kyra J. Becker

Introduction

229

(1)

The Ischemic Penumbra

229

(1)

Blood Pressure and Stroke

229

(2)

Glucose and Ischemic Brain Injury

231

(1)

Temperature and Brain Injury

232

(1)

Infection

232

(1)

Viscosity and Red Blood Cell Mass in Stroke

233

(1)

Miscellaneous Drugs and Therapeutic Interventions

233

(1)

Intracranial Pressure and Malignant Cerebral Edema

233

(2)

Stroke Units

235

(1)

Summary

235

(1)

References

235

(8)

Clinical Neuroprotective Trials in Ischemic Stroke

243

(8)

Wayne M. Clark

Helmi L. Lutsep

Introduction

243

(1)

Neuroprotection

243

(3)

Investigational Agents: Reperfusion Injury Agents

246

(1)

Conclusion

247

(1)

References

248

(3)

Prognosis and Outcomes Following Ischemic Stroke

251

(12)

L. Creed Pettigrew

Introduction

251

(1)

Medical Risk Factors for Progressing Stroke

251

(1)

Radiographic Indicators of Progressing Stroke

252

(2)

Thrombolysis, Risk of Hemorrhage, and Modification of Outcome in Acute Ischemic Stroke

254

(5)

Conclusions and Future Directions

259

(1)

References

260

(3)

Venous Strokes and Venous Sinus Thrombosis

263

(12)

Izabella Rozenfeld

Madeline C. Fields

Steven R. Levine

Introduction

263

(1)

Clinical Presentation

263

(1)

Epidemiology and Risk Factors

264

(2)

Pathogenesis

266

(1)

Natural History/Prognosis

267

(1)

Cerebral Venous Thrombosis in Children

268

(1)

Imaging/Diagnosis

268

(1)

Anatomy

269

(1)

Treatment

270

(2)

Summary and Conclusions

272

(1)

References

272

(3)

Section IV. Global Cerebral Ischemia

Animal Models of Global Cerebral Ischemia

275

(18)

Thaddeus S. Nowak, Jr.

Introduction

275

(1)

Histopathology of Global Ischemia

275

(2)

Global Ischemia Models

277

(4)

Control of Model Variability

281

(5)

Conclusions and Future Directions

286

(1)

References

286

(7)

Pathogenic Mechanisms of Brain Injury Following Global Cerebral Ischemia

293

(20)

Raymond C. Koehler

Sequence of Events During Complete and Incomplete Cerebral Ischemia

293

(1)

Sequence of Events During Reperfusion

294

(1)

Selective Vulnerability

294

(1)

Excitotoxicity

295

(1)

Calcium

296

(1)

Calpain

297

(1)

Nitric Oxide

297

(1)

Arachidonic Acid Metabolism

297

(1)

Reactive Oxygen Species

298

(1)

ER Stress

299

(1)

Apoptotic Pathways

300

(4)

Zinc

304

(1)

Conclusions and Future Directions

305

(1)

References

305

(8)

Management of Brain Injury Following Cardiopulmonary Arrest

313

(14)

Romergryko G. Geocadin

Introduction

313

(1)

Pathophysiologic Consideration

313

(1)

Controlled Clinical Trials of Brain-Directed Therapies After Cardiac Arrest

314

(2)

Clinical Trials in Hypothermia and Cardiac Arrest

316

(4)

Secondary Injuries that Affect Neurologic Outcome

320

(2)

Conclusions

322

(1)

References

323

(4)

Prognosis and Neurologic Outcomes Following Cardiopulmonary Arrest

327

(8)

Robert J. Wityk

Introduction

327

(1)

Clinical Syndromes

327

(1)

Prognosis and Clinical Predictors

328

(4)

Summary

332

(1)

References

333

(2)

Section V. Dogmas, Controversies, and Future Directions

Failure of Neuroprotective Agents to Show Benefit in Clinical Trials

335

(10)

Richard J. Traystman

Introduction

335

(1)

Mechanisms of Injury

335

(2)

Models

337

(1)

Drug Doses

337

(1)

Window of Opportunity

338

(1)

Anesthesia

338

(1)

Gender Differences

339

(1)

Health Characteristics of Animals

339

(1)

Combination Drug Therapy

340

(1)

Clinical Trials

340

(1)

Summary

340

(1)

References

341

(4)

Ischemic Preconditioning

345

(10)

Ines P. Koerner

Nabil J. Alkayed

Introduction

345

(1)

Clinical Relevance

345

(1)

Models of Preconditioning: Cross-Tolerance

346

(1)

Pharmacologic Preconditioning

346

(1)

Mechanisms of Ischemic Tolerance

346

(1)

Adenosine and KATP Channels

347

(1)

Mitochondrial KATP Channels

347

(1)

NMDA Receptors and Ca2+

347

(1)

Nitric Oxide in Preconditioning

347

(1)

Apoptosis Inhibitors and Bcl-2

347

(1)

Reactive Oxygen Species and Superoxide Dismutases

348

(1)

Inflammation in Ischemic Damage and Ischemic Tolerance

348

(1)

Preconditioning and Hibernation

348

(1)

Hypoxia-Inducible Factor 1 and Cytochrome P450

349

(1)

Conclusion and Future Directions

349

(1)

References

349

(6)

Therapeutic Potential of Hypothermia in Acute Stroke

355

(10)

Carmelo Graffagnino

Introduction

355

(1)

Background Pathophysiology of Ischemia

355

(1)

Mechanisms of Hypothermic Neuroprotection

355

(1)

Preclinical Work with Global Ischemia

356

(1)

Preclinical Work with Focal Ischemia

356

(1)

Human Experience with Hypothermia

357

(1)

Human Clinical Trials with Hypothermia for Global Ischemia (Cardiac Arrest)

358

(1)

Human Clinical Trials with Hypothermia for Focal Ischemia

359

(1)

Conclusions and Future Directions

360

(1)

References

360

(5)

Decompressive Hemicraniectomy for Stroke: An Old Therapy Revisited

365

(10)

Suresh Subramaniam

Michael D. Hill

Andrew M. Demchuk

Introduction

365

(1)

Clinical Course of Massive Cerebral Infarction

365

(1)

Identification of Patients for Hemicraniectomy

366

(1)

Description of Surgical Technique for Hemicraniectomy and Duraplasty

366

(2)

Key Issues to Address Prior to Hemicraniectomy

368

(3)

Conclusion

371

(1)

References

371

(4)

Blood-Pressure Management in Subarachnoid Hemorrhage, Acute Ischemic Stroke, and Intracerebral Hemorrhage

375

(14)

Wendy C. Ziai

Introduction

375

(1)

Cerebrovascular Physiology

375

(1)

Subarachnoid Hemorrhage

376

(2)

Ischemic Stroke

378

(3)

Intracerebral Hemorrhage

381

(3)

References

384

(5)

Diagnosis and Treatment of Cerebral Arteriovenous Malformations

389

(10)

Abhishek Srinivas

Stephen Chang

Philippe Gailloud

Introduction

389

(1)

Imaging of AVMs

389

(2)

AVM Grading System

391

(1)

Management of Cerebral AVMs

392

(3)

Conclusion

395

(1)

References

395

(4)

Endovascular Therapy for Carotid Stenosis

399

(6)

Alison J. Nohara

Introduction

399

(1)

Preparation for Carotid Stenting

400

(1)

Procedure

401

(1)

Routine Postprocedural Care

401

(1)

Complications

402

(1)

Summary and Conclusions

403

(1)

References

403

(2)

Acute Stroke Care Units: A Critical Appraisal

405

(10)

Paul A. Nyquist

Anish Bhardwaj

Introduction

405

(1)

Historic Perspective

405

(1)

ASU in the United States vs. Europe

406

(1)

European Literature and Databases

406

(1)

Need for ASU in the United States

407

(1)

ACUs: Definition and Composition

408

(2)

Human Resources in the ASU

410

(1)

Capabilities of an ASU

410

(1)

Configuration of ASU

410

(1)

Specific Issues Surrounding Care in ASUs

410

(2)

Summary and Conclusions

412

(1)

References

412

(3)

Telemedicine Applied to Stroke Care

415

(6)

Marian P. LaMonte

Mona N. Bahouth

Yan Xiao

Peter Hu

Colin Mackenzie

Introduction

415

(1)

Current Challenges in Providing Emergency Access to Stroke Specialty Care

415

(1)

Telemedicine as a Bridge from On-Site Emergency Providers to Specialists

415

(1)

Fundamental Research Advancing Telemedicine for Stroke Care

416

(2)

Reimbursement Challenges and Alternatives for Renewable Funding for Telemedicine Programs

418

(1)

Conclusions and Future Directions

418

(1)

References

419

(2)

Multimodality Neuromonitoring in Acute Stroke

421

(12)

Wolf-Dieter Heiss

Christian Dohmen

Rudolf Graf

Introduction

421

(1)

Studies in Experimental Stroke Models

421

(3)

Application of Multimodal Monitoring in the Neurologic Intensive Care Unit

424

(3)

Comparison to Functional Imaging

427

(2)

Conclusions and Future Directions

429

(1)

References

429

(4)

Gender Differences in Stroke Pathobiology: Therapeutic Implications

433

(10)

Louise D. McCullough

Julia Kofler

Patricia D. Hurn

Introduction

433

(1)

Role of Biologic Sex

433

(3)

Estrogen: Multiple Actions, Current Controversies

436

(3)

Testosterone: Role in Male Sensitivity to Ischemia

439

(1)

Conclusions

439

(1)

References

440

(3)

Ultrasonography in the Management of Acute Stroke

443

(16)

Andrei V. Alexandrov

Marc Ribo

Introduction

443

(1)

Transient Ischemic Attack vs. Stroke

443

(1)

Targets of Cerebrovascular Ultrasound Testing

444

(5)

Therapeutic Applications in Acute Ischemic Stroke

449

(2)

The CLOTBUST Trial

451

(1)

Other Clinical Trials

452

(1)

Conclusions and Future Directions

453

(1)

References

454

(5)

Acute Stroke in the Young

459

(14)

Heather J. Fullerton

Donna M. Ferriero

Introduction

459

(1)

Terminology, Incidence, and Epidemiology

459

(1)

Mechanisms of Injury in Stroke

460

(2)

Distribution and Clinical Presentation

462

(1)

Etiologies and Risk Factors

462

(3)

Diagnostic Evaluation

465

(1)

Management

465

(2)

Conclusions

467

(1)

References

468

(5)

Functional Recovery After Stroke with Cell-Based Therapy

473

(8)

Michael Chopp

Yi Li

Cell-Based Therapy: New Strategies for Stroke

473

(1)

Neurogenesis After Stroke

473

(1)

Sources of Cells for Treatment of Stroke

474

(1)

Modification of Cells in Stroke Research

475

(1)

Cell Therapy from the Laboratory to the Stroke Patient

476

(1)

Challenges in Cell-Based Therapy for Stroke: Determining the Mechanism of Cell Therapy

477

(1)

References

478

(3)

Brain Attack

481

(8)

Chandrasekaran Sivakumar

Alastair M. Buchan

Introduction

481

(1)

Imaging

481

(2)

Thrombolysis

483

(1)

Early Outcome

484

(1)

ICU Care

484

(1)

Decompressive Surgery

485

(1)

Neuroprotection

485

(1)

Acute Stroke Units

486

(1)

Biologic Markers

486

(1)

Telemedicine

486

(1)

Conclusions and Future Directions

486

(1)

References

487

(2)

Appendix: Abbreviations

489

(8)

Index

497

(18)

About the Editors

515

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Acute Stroke: Bench to Bedside

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Table of Contents

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