Handbook of stroke

496 Pages·2006·5.063 MB·English

by  David O. Wiebers, Valery L. Feigin, Robert D. Brown Jr. MD

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Handbook of Stroke
Second Edition
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Handbook of Stroke
Second Edition
David O.Wiebers,M.D.
Professor of Neurology
Mayo Clinic College of Medicine
Consultant,Departments of Neurology and Health Sciences
Research
Mayo Clinic and Mayo Foundation
Rochester,Minnesota
Valery L.Feigin,M.D.,D.Sc.
Professor of Neurology
Associate Professor of Medicine
Clinical Trials Research Unit
School of Public Health
University of Auckland
Auckland,New Zealand
Robert D.Brown,Jr.,M.D.,M.P.H.
Professor of Neurology
Mayo Clinic College of Medicine
Consultant,Department of Neurology
Mayo Clinic and Mayo Foundation
Rochester,Minnesota
Foreword by
Jack P.Whisnant,M.D.
Emeritus Professor of Neurology
Mayo Clinic College of Medicine
Consultant Emeritus,Department of Health Sciences Research
Mayo Clinic and Mayo Foundation
Rochester,Minnesota
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© 2006 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business
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1stEdition, ©1997 Mayo Foundation, Rochester, Minnesota. Published by
Lippincott-Raven Publishers.
All rights reserved. This book is protected by copyright. Nopartof this book may
be reproduced in any form by any means, including photocopying, or utilized by
any information storage and retrieval system without written permission from
thecopyright owner, except for brief quotations embodied in critical articles
andreviews. Materials appearing in this book prepared by individuals as part
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above-mentioned copyright. Printed in the USA
Library of Congress Cataloging-in-Publication Data
Wiebers, David O.
Handbook of stroke/David O. Wiebers, Valery L. Feigin, Robert D. Brown, Jr.;
foreword by Jack P. Whisnant.—2nd ed.
p.; cm.
Includes bibliographical references and index.
ISBN 0-7817-8658-4
1. Cerebrovascular disease—Handbooks, manuals, etc. I. Feigin, Valery L.
II.Brown, Robert D. (Robert Duane), 1961- III. Title.
[DNLM: 1. Cerebrovascular Disorders—complications. 2. Cerebrovascular
Disorders—diagnosis. 3. Cerebrovascular Disorders—therapy. 4. Acute Disease—
therapy. WL355 W642h 2006]
RC388.5.W463 2006
616.8’1—dc22
2005031125
Care has been taken to confirm the accuracy of the information presented and to
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For our patients,our colleagues,and our families
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Contents
Foreword........................................................................... xi
Preface............................................................................... xiii
I. Clinical and Laboratory Assessment
of Patients with Cerebrovascular
Disease
1. Systematic Clinical Assessment.............................. 3
2. Historical Evaluation of Key Signs
and Symptoms.......................................................... 7
3. General Medical Review.......................................... 37
4. General Examination............................................... 41
5. Neurologic Examination.......................................... 49
6. Approach to the Comatose Patient......................... 87
7. Laboratory Evaluation............................................. 103
Suggested Reading for Part I.................................. 130
II. Differential Diagnosis and Clinical
Features of Cerebrovascular
Disease
8. Differential Diagnosis Made Easy:
General Approach.................................................... 135
9. Temporal Profile of Ischemic
Cerebrovascular Diseases........................................ 139
Suggested Reading for Part II................................. 143
III. Management Before Determination
of the Mechanism of Cerebrovascular
Disease
10. Telephone Interview and Triage............................. 147
11. Management of Acute Stroke in Critically
Ill Patients................................................................ 153
12. Transient Ischemic Attack and Minor
Cerebral Infarction: General Evaluation
and Treatment.......................................................... 161
vii
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viii Contents
13. Major Cerebral Infarction: General
Evaluation and Treatment...................................... 175
14. Subarachnoid Hemorrhage: General
Evaluation and Treatment...................................... 185
15. Intracerebral Hemorrhage: General
Evaluation and Treatment...................................... 197
Suggested Reading for Part III............................... 206
IV. Medical and Surgical Management
Based on Specific Mechanisms
of Cerebrovascular Disease
16. Four Major Categories of Ischemic Cerebrovascular
Disease: Identification and Treatment................... 213
17. Five Major Categories of Hemorrhagic
Disease: Treatment of Specific Underlying
Mechanisms.............................................................. 241
18. Cerebral Venous Thrombosis................................... 259
19. Other Cerebrovascular Syndromes......................... 263
20. Vascular Disease of the Spinal Cord....................... 267
21. Cerebrovascular Disease in Children and
Young Adults............................................................ 273
22. Cerebrovascular Disease in Pregnant
Patients..................................................................... 281
23. Cerebrovascular Disease Genetics.......................... 291
Suggested Reading for Part IV................................ 296
V. Primary Prevention of
Cerebrovascular Disorders
24. Modifiable Lifestyle and Environmental
Factors...................................................................... 305
25. Asymptomatic Carotid and Vertebral
Stenosis..................................................................... 311
26. Hypertension............................................................ 315
27. Dyslipidemia............................................................. 319
28. Other Host Factors.................................................. 325
29. Unruptured Intracranial Aneurysms..................... 329
30. Unruptured Intracranial Vascular
Malformations.......................................................... 335
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Contents ix
31. Hematologic Disease................................................ 341
Suggested Reading for Part V................................. 342
VI. Assessing and Discussing Prognosis
and Natural History of Cerebrovascular
Disorders
32. Carotid or Vertebral Artery Occlusive
Disease...................................................................... 349
33. Transient Ischemic Attack....................................... 353
34. Cerebral Infarction.................................................. 355
35. Intracerebral Hemorrhage...................................... 359
36. Subarachnoid Hemorrhage...................................... 363
Suggested Reading for Part VI................................ 365
VII. Management and Rehabilitation
After Stroke
37. Physical Therapy..................................................... 369
38. Speech Therapy........................................................ 375
39. Other Chronic Complications of Stroke.................. 377
40. Family and Patient Education................................ 381
Suggested Reading for Part VII.............................. 383
Appendixes
A. Clinical Anatomy of the Brain and Spinal
Cord Vascular System.............................................. 387
A-1. Brain and spinal cord vascular anatomy and
syndromes................................................................. 387
A-2. Central nervous system ischemic vascular
syndromes................................................................. 402
A-3. Symptoms of unruptured intracranial
aneurysms................................................................ 405
A-4. Differential signs indicating hemispheric
localization of intellectual deficits.......................... 407
B. Glasgow Coma Scale................................................ 409
C. Functional Status Scales (Stroke
Severity Scales)........................................................ 411
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C-1. Barthel index............................................................ 411
C-2. Stroke Scale of National Institutes of
Health-National Institute of Neurological
Disorders and Stroke (NIH-NINDS)....................... 415
C-3. Modified Rankin disability scores........................... 419
C-4. Clinical grades of subarachnoid
hemorrhage............................................................... 420
D. Stroke and Cardiovascular Risk Profiles............... 421
D-1. Probability of stroke within 10 years for
men who are aged 55–84 years and have no
previous stroke......................................................... 421
D-2. Probability of stroke within 10 years for
women who are aged 55–84 years and have no
previous stroke......................................................... 422
D-3. New Zealand cardiovascular risk
prediction charts...................................................... 424
E. Practice Guidelines for Management of
Cerebrovascular Disease......................................... 427
E-1. Guideline for initial evaluation by
telephone of a patient with cerebrovascular
disease....................................................................... 428
E-2. Guideline for transient ischemic attack/
reversible ischemic neurologic deficit/
minor ischemic stroke.............................................. 430
E-3. Guideline for major ischemic stroke....................... 432
E-4. Guideline for subarachnoid hemorrhage................ 434
E-5. Guideline for intracerebral/intraventricular
hemorrhage............................................................... 436
E-6. Guideline for asymptomatic carotid artery
stenosis..................................................................... 438
F. Outline of Diets Low in Fat and Cholesterol
and Table of Ideal Body Weight.............................. 441
F-1. Low-fat, low-cholesterol diet................................... 441
F-2. Very-low-fat, very-low-cholesterol diet................... 443
F-3. Metropolitan Height and Weight Tables................ 446
Subject Index....................................................................... 447