Current Review of Cerebrovascular Disease PDF
Preview Current Review of Cerebrovascular Disease
Current Review of -----==-= Cerebrovascular Disease -===== - Fourth Edition Current Review of __ -===0=== Cerebrovascu !ar Disease_~ Fourth Edition Edited by MARC FISHER, MD Professor of Neurology University of Massachusetts Medical School Worcester, Massachusetts, USA JULIEN BOGOUSSLAVSKY, MD Professor Department of Neurology University Lausanne Lausanne, Switzerland With 49 Contributors Developed by Current Medicine, Inc. Philadelphia Current Medicine, Inc. eM 400 Market Street Suite 700 CURRENT. MEDICINE Philadelphia, PA 19106 Director of Product Development: Charles Field Developmental Editor: Elise M. Paxson Assistant Editor: Annmarie D'Ortona Editorial Supervisor: Fran Klass Art and Illustration Director: Wendy Vetter Design and Layout:)ennifer Knight Senior Illustrator: Wiesia Langenfeld Illustrator: Maureen Looney Production Manager: Lori Holland Assistant Production Manager: Simon Dickey Index: Holly Lukens For more information please call 1-800-427-1796 or e-mail [email protected] www.current-science-group.com Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of the information contained herein. Any product mentioned in this publication should be used in accordance with the prescribing information prepared by the manufacturers. No claims or endorsements are made for any drug or compound at present under clinical investigation. ISBN-13: 978-1-4684-0003-8 e-ISBN-13: 978-1-4684-0001-4 001: 10.1007/978-1-4684-0001-4 "'Copyright 1999, 1996, 1990, 2001 by Current Medicine, Inc., 400 Market Street, Suite Softcover reprint of the hardcover 4th edition 2001 700, Philadelphia, PA 19106. All rights reserved. No part of this publication may be repro duced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. Contents-----------=======~- Cl-t [R 1 NEW ApPROACHES TO ATHEROSCLEROSIS BASED ON ENDOTHELIAL FUNCTION J. David Spence Biology of Atherosclerosis ................................................................................................. 1 The Endothelium: Not Just Plastic Wrap .................................................................................. 2 Postmenopausal Hormone Replacement Therapy ........................................................................ 2 Antioxidants .............................................................................................................. 3 Homocyst(e)ine ........................................................................................................... 4 Postprandial Lipids ........................................................................................................ 5 Compensatory Enlargement .............................................................................................. 6 Measurement of Atherosclerosis .......................................................................................... 7 A Paradigm Shift to Management of Arteries, Not Risk Factors .......................................................... 11 Genetics .................................................................................................................. 11 Conclusions .............................................................................................................. 12 CH [R 2 MECHANISMS OF NEURONAL CELL DEATH AFTER ISCHEMIC INJURY TO THE BRAIN Zhu-Rong Ye, Kai-Feng Liu, and Julio H. Garcia Historical Background .................................................................................................... 15 Definition ................................................................................................................ 16 Morphologic Identification of Dead Cells ................................................................................ 16 Differences Between Necrosis and Apoptosis ............................................................................ 17 Delayed Neuronal Death ................................................................................................. 18 Conclusions .............................................................................................................. 22 CI.j TER 3 GROWTH FACTORS AND CEREBRAL ISCHEMIA IIknur Ay, Hakan Ay, Walter J. Koroshetz, and Seth P. Finklestein Prevention ............................................................................................................... 25 Acute Treatment ......................................................................................................... 26 Recovery ................................................................................................................. 30 Conclusions .............................................................................................................. 31 CH PHR THE ISCHEMIC PENUMBRA AND THE THERAPEUTIC TIME WINDOW Marc Fisher Concepts and Evolution ofthe Ischemic Penumbra ...................................................................... 35 Evolution of the Ischemic Penumbra to Irreversible Injury ............................................................... 40 The Therapeutic Time Window .......................................................................................... 41 CH P~ 5 TEMPERATURE CHANGES AND ISCHEMIC STROKE W. Dalton Dietrich Global and Focal Cerebral Ischemia ...................................................................................... 45 Limitations of Postischemic Hypothermia ............................................................................... 46 The Importance of Chronic Outcome Measures in Assessing Neuroprotective Strategies ............................... 46 Fever and Ischemic Hyperthermia ....................................................................................... 47 Temperature Measurements in the Clinical Setting ...................................................................... 48 Temperature Mechanisms ............................................................................................... 50 Future Applications to Stroke Treatment ................................................................................ 52 V CI1 HR 6 DIFFUSION-WEIGHTED AND PERFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING IN CLINICAL STROKE Christian Beaulieu and Michael E. Moseley Diagnostic Value of the Magnetic Resonance Imaging Examination ..................................................... 59 Perfusion-Weighted Magnetic Resonance Imaging in Stroke ............................................................. 62 Prognostic Value ......................................................................................................... 63 Emerging Magnetic Resonance Imaging Techniques for Clinical Stroke .................................................. 65 Conclusions .............................................................................................................. 68 CHAP-ER 7 NEW TRENDS IN NEUROSONOLOGY Gerald Devuyst, Vendel Kemeny, Paul-Andre Despland The Most Predictive Parameters of an Internal Carotid Artery Stenosis .................................................. 71 Reproducibility of Ultrasound Assessment of Carotid Plaques and Their Relationship with the Risk of Stroke .......... 72 Power Doppler Imaging .................................................................................................. 73 Transcranial Color-Coded Duplex Sonography Versus Magnetic Resonance Angiography .............................. 74 Contrast-or Echo-Enhanced Transcranial Duplex Imaging ............................................................... 74 Harmonic Contrast Imaging ............................................................................................. 77 Three-Dimensional Transcranial Power Doppler Ultrasound Imaging ................................................... 78 Microembolic Signals .................................................................................................... 78 Patent Foramen Ovale ................................................................................................... 82 Cardiac Ultrasound ...................................................................................................... 82 Conclusions .............................................................................................................. 82 MAGNETIC RESONANCE ANGIOGRAPHY johannes Weber and Michael Forsting Basic Principles ........................................................................................................... 85 Clinical Applications in Cerebrovascular Diseases ........................................................................ 88 Conclusions .............................................................................................................. 91 CHAPTER 9 COMPUTED TOMOGRAPHY ANGIOGRAPHY AND PERFUSION IMAGING OF ACUTE STROKE Michael H. Lev, George j. Hunter, Leena M. Hamberg, and R. Gilberto Gonzalez Helical CT Imaging ....................................................................................................... 93 The Role of Noncontrast CT in Acute Stroke ............................................................................ 94 The Role of Contrast CT in Acute Stroke ................................................................................ 95 Combined CT Angiogram and Steady State CT Perfusion Imaging ...................................................... 95 First-Pass CT Perfusion Imaging .......................................................................................... 96 Rapid Triage to Appropriate Treatment .................................................................................. 96 Conclusions .............................................................................................................. 98 CHAPTER 10 CLINICAL EVALUATION OF STROKE Mehmet ZulkujOnal, Marc Fisher, and julien Bogousslavsky Emergency Evaluation .................................................................................................. 102 Differential Diagnosis ................................................................................................... 102 Clinical Features of Stroke .............................................................................................. 103 Classification of Stroke .................................................................................................. 105 Quantification of the Neurologic Deficit ............................................................................... 107 Conclusions ............................................................................................................. 110 VI 1 LACUNAR STROKE Rene J. Metz and Julien Bogousslavsky Clinical Interest of the Lacunar Hypothesis ............................................................................. 115 Ataxic Hemiparesis and Pure Motor Stroke ............................................................................. 116 Remarkable Clinical Features of Lacunar Infarcts .. , ...................................... , ............................. 117 Functional Outcome of Lacunar Strokes ................................................................................ 117 Stroke Recurrence in Lacunar Infarction ................................................................................ 118 New Insights in Risk Factors Involved in Lacunar Infarction ............................................................. 118 Pathophysiology of Lacunar Infarction ................................................................................. 120 Imaging Lacunes ........................................................................................................ 121 Conclusions ............................................................................................................. 121 CARDIOEMBOLIC STROKE Andrew R. Wooifenden and Gregory W. Albers Echocardiography in Stroke ....................... , .................................................................... 123 Atrial Fibrillation ........................................................................................................ 123 Other Rhythm Disturbances ............................................................................................ 128 Prosthetic Valves ........................................................................................................ 128 Valvular Heart Disease .................................................................................................. 130 Myocardial Infarction ................................................................................................... 130 Heart Failure and Cardiomyopathy ..................................................................................... 131 Patent Foramen Ovale .................................................................................................. 131 Spontaneous Echo Contrast and Left Atrial-Atrial Appendage Thrombus ............................................. 132 Endocarditis ............................................................................................................ 133 Cardiac Tumors ......................................................................................................... 133 r AORTIC ARCH ATHEROSCLEROTIC DISEASE Olivier Heinzlej, Ariel Cohen, and Pierre Amarenco Case-Control Studies ................................................................................................... 137 Aortic Arch Plaques as a Risk Factorfor Ischemic Stroke ............................................................... 139 Prospective Studies ..................................................................................................... 139 Treatment .............................................................................................................. 140 Conclusions ............................................................................................................. 140 SUBARACHNOID HEMORRHAGE Gabriel).E. Rinkel Epidemiology ........................................................................................................... 143 Causes Other Than Aneurysms ......................................................................................... 145 Management of Aneurysmal Subarachnoid Hemorrhage .............................................................. 148 Prevention of Subarachnoid Hemorrhage .............................................................................. 152 VII C ~ ~ VASCULAR DEMENTIA Didier Leys, Lucilla Parnetti, and Florence Pasquier Diagnostic Criteria ...................................................................................................... 157 Descriptive Epidemiology .............................................................................................. 158 Clinical Features ........................................................................................................ 159 Risk Factors ............................................................................................................. 160 Mechanisms of Vascular Dementia ..................................................................................... 160 Role of White Matter Changes ................................... : ...................................................... 161 Does Dementia Predict a Worse Outcome in Stroke Patients? ......................................................... 163 Therapy ................................................................................................................. 163 Management of Patients with Vascular Dementia ...................................................................... 164 Conclusions ............................................................................................................. 165 CH "'P~[ PROGRESSING STROKE Antoni Davalos and Jose Castillo Definitions and New Concepts on Progressing Stroke .................................................................. 169 Epidemiology, Clinical Characteristics, and Outcome ................................................................... 170 Risk Factors of Progressing Stroke ....................................................................................... 171 Novel Biochemical and Imaging Techniques in the Diagnosis of Progressing Stroke .................................... 173 Mechanisms Leading to Cell Death After an Acute Stroke .............................................................. 174 Management of Acute Stroke to Limit the Damaging Effects of Progressing Stroke .................................... 178 Conclusions ............................................................................................................. 178 ( 7 ANTITHROMBOTIC THERAPY IN STROKE Thierry Moulin, Laurent Tatu, and Fabrice Vuillier Preventive Treatment in Stroke ......................................................................................... 183 Indications of Acute Anticoagulation ................................................................................... 189 CH r~ NEUROPROTECTIVE THERAPY Nils Gunnar Wahlgren and Magnus Thoren Maintaining Perfusion Pressure ......................................................................................... 197 Time Windows for Therapeutic Intervention ........................................................................... , 98 What Can We Expect from Neuroprotective Therapy? ................................................................ 199 Is Stroke Subtype Important for Outcome of Neuroprotective Therapy? .............................................. 199 Neuroprotective Treatment Strategies 1: Inhibition of the Ischemic Cascade ........................................... 199 Neuroprotective Treatment Strategies 2: Inhibition of Reperfusion Injury .............................................. 203 Neuroprotective Treatment Strategies 3: Relearning Therapeutic Strategy ............................................. 204 The Future Prospective: Combined Therapies .......................................................................... 204 VIII THROMBOLYTIC THERAPY Irene L. Katzan and Anthony J. Furlan Intravenous Thrombolysis Trials ........................................................................................ 207 Intra-Arterial Thrombolysis ............................................................................................. 210 Vertebrobasilar Thrombolysis .......................................................................................... 211 Risks of Hemorrhagic Transformation .................................................................................. 212 Other Factors Affecting Outcomes with Thrombolysis ................................................................. 213 Thrombolysis in the Community Setting ............................................................................... 213 Ancrod ................................................................................................................. 214 Conclusions ............................................................................................................. 214 SURGICAL THERAPY Yasuhiro Yonekawa, Javier Fandino, and Ethan raub Cerebral Ischemia ....................................................................................................... 220 Cerebral Aneurysm ..................................................................................................... 224 Aneurysm Surgery ...................................................................................................... 227 Arteriovenous Malformations .......................................................................................... 229 Cavernous Angioma .................................................................................................... 230 Conclusions ............................................................................................................. 230 STROKE IN DEVElOPING COUNTRIES N. Venketasubramanian Stroke Mortality ........................................................................................................ 233 Stroke Incidence ........................................................................................................ 235 Stroke Prevelance ....................................................................................................... 235 Stroke Subtypes ........................................................................................................ 236 Health Care Facilities .................................................................................................... 237 Traditional Medicine .................................................................................................... 238 Solutions ................................................................................................................ 238 Conclusions ............................................................................................................. 238 MEGA TRIALS VERSUS SMALL TRIALS IN STROKE Peter Sandercock, Michael G. Hennerici, Jean-Marc Orgogozo, Stephen M. Davis, and Philip B. Gorelick Editor's Commentary ................................................................................................... 241 The Need for Large-Scale Randomized Evidence in Acute Stroke Perspective: Peter Sandercock ............................................................................................ 242 The Importance of Small Acute Stroke Trials Perspective: Michael G. Hennerici ......................................................................................... 242 Perspective: Jean-Marc Orgogozo ......................................................................................... 243 The Importance of Both Mega Trials and Small Trials Perspective: Stephen M. Davis ............................................................................................ 244 Are More Subjects Better in a Randomized Controlled Trial? Perspective: Philip B. Gorelick ............................................................................................. 245 Index .................................................................................................................... 247 Color Plates IX Contributors GREGORY W. ALBERS, MD STEPHEN M. DAVIS, MD, FRACP R. GILBERTO GONZALEZ, MD, PHD Professor Professor Harvard Medical School Department of Neurology Department of Medicine Department of Radiology Stanford University University of Melbourne; Division of Neuroradiology Stanford, California Director of Neurology Massachusetts General Hospital Director The Royal Melbourne Hospital Stanford Stroke Center Melbourne, Australia PHILIP B. GORELICK, MD, MPH, Palo Alto, California FACP GERALD DEVUYST, MD Professor of Neurological Sciences PIERRE AMARENCO, MD Chief of Clinic Rush Medical Center Staff Physician Department of Neurology Center for Stroke Research Department of Neurology University Lausanne Chicago, Illinois Lariboisiere Hospital Lausanne, Switzerland Paris, France OLIVIER HEINZLEF, MD W. DALTON DIETRICH, PHD Senior Registrar HAKANAY,MD Professor Department of Neurology Research Fellow Department of Neurosurgery Pierre and Marie Curie University Department of Neurology University of Miami Paris, France Harvard Medical School Scientific Director Boston, Massachusetts The Miami Project to Cure Paralysis MICHAEL G. HENNERICI, MD Miami, Florida Professor of Neurology ILKNUR AY, MD Chairman, Department of Neurology Research Fellow JAVIER FANDINO, MD University of Heidelberg Department of Neurology Department of Neurosurgery Medical School Mannheim Harvard Medical School University Hospital Mannheim, Germany Boston, Massachusetts Zurich, Switzerland LEENA M. HAMBERG, PHD CHRISTIAN BEAULIEU, PHD SETH P. FINKLESTEIN, MD Harvard Medical School Assistant Professor Associate Professor Department of Radiology Department of Biochemical Engineering Department of Neurology Division of Neuroradiology University of Alberta Harvard Medical School; Massachusetts General Hospital Edmonton, Alberta, Canada Associate Neurologist Massachusetts General Hospital GEORGEj. HUNTER, MD Boston, Massachusetts JULIEN BOGOUSSLAVSKY, MD Harvard Medical School Professor Department of Radiology Department of Neurology MARC FISHER, MD Division of Neuroradiology University Lausanne Professor of Neurology Massachusetts General Hospital Lausanne, Switzerland University of Massachusetts Medical School IRENE l. KATZAN, MD Worcester, Massachusetts JOSE CASTILLO, MD, PHD Clinical Associate Professor of Neurology Department of Neurology Universidad de Santiago de Compostela MICHAEL FORSTING, MD Cleveland Clinic Foundation Department of Neurology Professor of Neuroradiology Cleveland, Ohio Hospital Xeral de Galicia Department of Neuroradiology Santiago de Compos tela, Spain University of Essen WALTERJ. KOROSHETZ, MD Essen, Germany Associate Professor ARIEL COHEN, MD Department of Neurology Professor of Cardiology ANTHONY J. FURLAN, MD Harvard Medical School Department of Cardiology Head, Section of Stroke and Neurologic Boston, Massachusetts Pierre and Marie Curie University Intensive Care Paris, France Department of Neurology MICHAEL H. LEV, MD Cleveland Clinic Foundation Instructor in Radiology Cleveland, Ohio ANTONI DAVALOS, MD, PHD Department of Radiology Chairman, Section of Neurology and Harvard Medical School Stroke Unit JULIO H. GARCIA, MD (deceased) Director of Emergency Neuroradiology Hospital Universitari de Girona Doctor Professor of Pathology Massachusetts General Hospital Josep Trueta Head, Division of Neuropathology Boston, Massachusetts Girona, Spain Henry Ford Hospital Detroit, Michigan x DIDIER LEYS, MD FLORENCE PASQUIER, MD, PHD N. VENKETASUBRAMANIAN, MBBS, Professor of Neurology Professor of Neurology M MED (INTERNAL MEDICINE), Department of Neurology, Stroke Unit Department of Neurology, Memory Unit FAMS (NEUROLOGY) University of Lille University of Lille Clinical Teacher Lille, France Lille, France Faculty of Medicine National University of Singapore KAI-FENG lIu, MD GABRIELJ.E. RINKEL, MD Singapore Senior Research Associate Assistant Professor Department of Anesthesiology Department of Neurology FABRICE VUILUER, MD Henry Ford Hospital University of Utrecht Department of Neurology Detroit, Michigan Utrecht, the Netherlands Besancon University School of Medicine Besancon, France RENEJ. METZ, MD PETER SANDERCOCK, MA, DM, Neurologist FRCPE NILS GUNNAR WAHLGREN, MD, PHD Department of Neurology Professor Associate Professor of Neurology Universite Catholique de Louvain Clinical Neurosciences Karolinska Institute Hospital Brussels, Belgium Edinburgh University; Stockholm, Sweden Honorary Consultant Neurologist Western General Hospital MICHAEL E. MOSELEY, PHD JOHANNES WEBER, MD Assistant Professor Edinburgh, UK Fellow Department of Radiology Department of Neuroradiology Stanford University J. DAVID SPENCE, BA, MD, FRCPe, University of Essen Stanford, California FACP Essen, Germany Professor THIERRY MOULIN, MD, PHD Department of Clinical Neurological ANDREW R. WOOLFENDEN, MD, Professor of Neurology Sciences, Medicine, and Pharmacology FRCPC Besancon University School of Medicine University of Western Ontario Clinical Instructor Besancon, France London, Ontario, Canada University of British Columbia Vancouver, British Columbia, Canada MEHMET ZOLKOF ONAL, MD LAURENT TATU, MD Assistant Professor Department of Neurology ZHu-RONG YE, MD Department of Neurology University Hospital Besancon Professor of Pathology University of Antalya Besancon, France Medical Center of Fudan University Antalya, Turkey (formerly Shanghai Medical University) ETHAN T AUB, MD Shanghai, China JEAN-MARC ORGOGOZO, MD Oberarzt Professor Department of Neurosurgery YASUHIRO YONEKAWA, MD Department of Neurology University Hospital Professor and Director Victor Segalen Medical School Zurich, Switzerland Department of Neurosurgery CHU Pellegrin University Hospital Bordeaux, France MAGNUS THOREN, MD Zurich, Switzerland Department of Neurology Preface LUCILLA PARNETTI, MD, PHD Karolinska Institute Hospital Research Scientist Stockholm, Sweden Docent of Neurology Institute of Clinical, Mental, and Nervous Diseases University of Perugia Perugia, Italy XI
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