Brain Embolism

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ISBN: 9780824729295 | 0824729293
Cover: Hardcover
Copyright: 7/11/2006

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The only source to fully cover every aspect of brain embolism, this guide analyzes the causes, symptoms, diagnosis, and management of this disorder-providing a detailed overview of major topics pertinent to embolism including donor sources, recipient sites, embolic material, recipient brain supply arteries, vascular and brain pathology, and the treatment of cardiac and arterial sources. Clearly guiding readers through key anatomical structures, diagnostic developments, therapeutic advances, and best practices in clinical care, this source will serve as a must-have desk reference for any clinician in the field.

Preface

iii

Contributors

Part I: Historical Background and Overview

Historical Background: Development of Ideas and Knowledge about Stroke and Brain Embolism

(24)

Louis R. Caplan

Early Writers---Description of Apoplexy and Interest in Anatomy

(2)

The 18th Century: Morgagni---The Beginning of Modern Pathology

(1)

The First Half of the 19th Century---Recognition of Brain Infarction and a Relationship with Heart Disease

(3)

The Second Half of the 19th Century---Cardiac Embolism Becomes an Established Clinical Entity

(1)

The First Half of the 20th Century---An Emphasis on Vascular Anatomy

(5)

Data Banks and Stroke Registries

(4)

New Technology and Further Studies Clarify More Potential Donor Sources of Emboli

(1)

Brain and Vascular Investigations Bring Embolism to the Forefront as the Major Cause of Brain Infarction

(1)

References

(6)

Overview: The Major Components of Brain Embolism

(6)

Louis R. Caplan

The Recipient Arteries

(2)

The Embolic Material

(1)

The Donor Source

(1)

References

(2)

Part II: Recipient Arteries and Brain Ischemia

Recipient Artery: Anatomy and Pathology

(30)

Louis R. Caplan

Examining Recipient Arteries to Separate Embolism and Thrombosis

(2)

Hemorrhagic Infarction

(3)

Location, Types, and Size of Embolic Brain Infarcts

(22)

References

(3)

Recipient Artery: Clinical Symptoms and Signs of Brain Ischemia

(20)

Louis R. Caplan

General Clinical Features and Diagnosis

(6)

Anterior Carotid Artery Circulation Embolism

(3)

Posterior Circulation Vertebro-Basilar Arteries Embolism

(7)

References

(4)

The Eye as the Recipient Artery

(12)

Louis R. Caplan

Anatomy of the Arteries that Supply the Eye

(2)

Clinical Symptoms and Signs of Eye Ischemia

(4)

Methods of Investigating the Eye as a Recipient Site of Embolism

(1)

Differential Diagnosis of Retinal Embolism

(1)

Usual Sources of Retinal Embolism

(1)

Treatment

(1)

References

(3)

Imaging Evaluation: Recipient Artery Sites

(20)

Louis R. Caplan

Brain Neuroimaging

(4)

Intracranial Vascular Imaging

(4)

Magnetic Resonance Perfusion Imaging and Complete Magnetic Resonance Protocols

101

(3)

Computed Tomography Perfusion and Complete Computed Tomography Protocols

104

(2)

Other Techniques for Studying Perfusion

106

(3)

References

109

(4)

Transcranial Doppler Ultrasound

113

(16)

Carlos A. Molina

Andrei V. Alexandrov

Introduction

113

(1)

TCD Diagnosis of Arterial Occlusions

114

(3)

TCD Monitoring During Thrombolysis

117

(4)

Detection of Intracranial Artery Stenosis and Artery-to-Artery Embolism

121

(1)

Emboli Monitoring

122

(1)

Detection of Right-to-Left Shunts

123

(1)

References

124

(5)

Part III: Donor Sources---Nature, Frequency, Recognition

Cardiac Sources of Embolism: The Usual Suspects

129

(32)

Louis R. Caplan

Warren J. Manning

Arrhythmias

130

(1)

Cardiac Valve Disease

131

(1)

Aortic Valve Disease

132

(5)

Infective Endocarditis

137

(2)

Noninfective Fibrous and Fibrinous Endocardial Lesions (Including Valve Strands)

139

(5)

Myocardial and Cardiac Chamber Lesions

144

(3)

Cardiac Myxomas and Other Tumors

147

(1)

Paradoxical Embolism and Cardiac Septal Lesions

148

(3)

References

151

(10)

Cardiac Source of Embolism: Pathophysiology and Identification

161

(26)

Warren J. Manning

Major Sources of Emboli

161

(1)

Left Atrial Anatomy and Imaging

161

(1)

Left Atrial Thrombi

162

(1)

Mitral Stenosis

163

(2)

Atrial Fibrillation

165

(4)

Left Ventricular Thrombi

169

(1)

Myocardial Infarction

170

(1)

Dilated Cardiomyopathy

171

(1)

Prosthetic Valve Thrombi

171

(1)

Aortic Atherosclerosis

171

(1)

Infective Endocarditis

172

(1)

Valvular Calcification

173

(1)

Valve Excrescences

173

(1)

Mitral Annular Calcification

174

(1)

Intracardiac Tumors

174

(1)

Left Atrial Spontaneous Echo Contrast

175

(1)

Abnormalities of the Interatrial Septum

176

(3)

Imaging Procedures

179

(1)

Summary and Recommendations

179

(1)

References

180

(7)

The Aorta as a Donor Source of Brain Embolism

187

(16)

Louis R. Caplan

Early Pathology-Based Reports of Embolism from the Aorta

187

(1)

Aortic Atherosclerosis

187

(4)

Heart Surgery and Aortic Atherosclerosis

191

(3)

Encephalopathy, Cognitive, and Neurobehavioral Abnormalities After Heart Surgery

194

(2)

Imaging of the Proximal Aorta

196

(2)

References

198

(5)

Arterial Sources of Embolism

203

(20)

Louis R. Caplan

Diseases, Pathology, and Pathophysiology

203

(1)

Atherosclerosis

203

(2)

Arterial Dissections

205

(1)

Fibromuscular Dysplasia

205

(3)

Arterial Aneurysms and Dolichoectatic Arteries

208

(1)

Distribution of Arterial Lesions

209

(4)

Relation of Symptoms to Severity of Atherosclerotic Arterial Stenosis

213

(3)

Imaging and Laboratory Evaluation of Potential Donor Sources of Embolism

216

(3)

References

219

(4)

Ultrasound of Cervical Arteries

223

(20)

Michael Hennerici

Hansjoerg Baezner

Michael Daffertshofer

Intima--Media Thickness: The Initial Stage of Arterial Disease

223

(3)

Plaque Development: The Intermediate Stage of Arterial Disease

226

(8)

Plaque Development: The Final Stage

234

(2)

References

236

(7)

Part IV: Pathophysiology

Vascular Hemostasis and Brain Embolism

243

(16)

Gregory J. del Zoppo

Thrombosis and the Pathophysiology of Brain Ischemia

244

(1)

Cerebrovascular Thrombosis

245

(2)

Hemorrhagic Transformation

247

(1)

Stroke and Consumptive Coagulopathy

248

(1)

Platelet Activation

249

(1)

Thrombin Generation

249

(1)

Fibrin Degradation

249

(1)

Endogenous Protective Mechanisms

250

(1)

Cerebrovascular Reservoir

250

(1)

Collateral Circuits

250

(1)

Microvessel-Associated Protection

250

(1)

Endogenous Thrombus Lysis

251

(1)

Vascular Matrix Degradation

251

(1)

Modulation of Thrombin Activity

252

(1)

Microvessel Integrity, Hemostasis, and Selective Neuron Vulnerability

253

(1)

Summary

253

(1)

References

254

(5)

Part V: Embolic Materials

Embolic Particles

259

(18)

Louis R. Caplan

Cardiac-Origin Substances

259

(5)

Arterial Origin Sources

264

(1)

Substances that Originate from Outside the Cardiovascular Systems

264

(1)

Fat Embolism

264

(4)

Air Embolism

268

(1)

Tumor Embolism

269

(1)

Foreign Body Embolism

270

(1)

References

271

(6)

Part VI: Treatment

Treatment of the Acute Embolic Event

277

(12)

Louis R. Caplan

Reperfusion

277

(5)

Anticoagulation

282

(1)

Neuroprotective Agents

283

(1)

Managing Brain Edema and Mass Effect

284

(1)

References

284

(5)

Cardiac Source of Embolism: Treatment

289

(30)

Warren J. Manning

Atrial Fibrillation

289

(1)

New Onset Atrial Fibrillation

289

(8)

Recurrent or Persistent Atrial Fibrillation

297

(1)

Atrial Fibrillation Risk Profile

298

(2)

Combination Therapy

300

(9)

Abnormalities of the Interatrial Septum

309

(2)

References

311

(8)

Treatment of Aortic and Arterial Sources

319

(16)

Louis R. Caplan

Treatment of Aortic Atheromatosis

319

(1)

Treatment of Arterial Source Emboli

320

(3)

Substances that Alter Fibrinogen Concentrations

323

(1)

Anticoagulants

324

(2)

Surgical and Interventional Treatments

326

(2)

References

328

(7)

Part VII: The Future

A Look Towards the Future

335

(6)

Louis R. Caplan

Warren J. Manning

Diagnostic Advances

335

(3)

Therapeutic Advances

338

(1)

Thrombolysis

338

(1)

Mechanical Devices

338

(1)

Antiplatelet Agents

339

(1)

Anticoagulants

339

(1)

Neuroprotectants

340

(1)

Personnel and Systems of Care

340

(1)

Index

341

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Brain Embolism

Summary

Table of Contents

Supplemental Materials