New Trends in Diagnosis and Management of Stroke

147 Pages·1987·3.53 MB·English

by  E. B. Ringelstein (auth.), Professor Dr. Klaus Poeck, Professor Dr. Erich Bernd Ringelstein, Professor Dr. Werner Hacke (eds.)

New Trends
in Diag_no_s_is_ _
and Management
of Stroke
Edited by
K. Poeck E. B. Ringelstein W. Hacke
With Contributions by
G. W. Bielenberg H. K. Breddin G. J. Del Zoppo
H. J. Gelmers K. Gorter W. Hacke L. A. Harker
H. Henningsen C. Kessler G. Korbmacher
J. Krieglstein H. J. Krzywanek J. Marshall
E. B. Ringelstein H.-J. Stierstorfer C. J. de Weerdt
J. H. A. Wiezer H. Zeumer
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Professor Dr. KLAUS POECK
Professor Dr. ERICH BERND RINGELSTEIN
Abteilung Neurologie der Medizinischen FakulUit
Rheinisch-WesWilische-Hochschule
PauwelsstraBe, D-5100 Aachen
Professor Dr. WERNER HACKE
Abteilung Neurologie, Universitat Heidelberg
Kopfklinikum
1m Neuenheimer Feld 400, D-6900 Heidelberg
With 42 Figures
ISBN-13: 978-3-540-18369-3 e-ISBN-13: 978-3-642-72996-6
DOl: 10.1007/978-3-642-72996-6
Library of Congress Cataloging-in-Publication Data. New trends in diagnosis and management of
stroke 1 edited by K. Poeck, E. B. Ringelstein, and W. Hacke; with contributions by G. W. Bielenberg
... let al.]. p. cm. Bibliography: p. Includes index.
I. Cerebrovascular disease - Congresses. I. Poeck, Klaus. II. Ringelstein, E. B. (Erich Bernd),
1948- . III. Hacke, W. (Werner). 1948- .
RC388.5.N475 1987 616.8'I-dc 19 87-28454 CIP.
This work is subject to copyright. All rights are reserved, whether the whole or part of the material
is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broad
casting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this
publication or parts thereof is only permitted under the provisions of the German Copyright Law of
September 9, 1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations
fall under the prosecution act of the German Copyright Law.
© Springer-Verlag Berlin Heidelberg 1987
The use of registered names, trademarks, etc. in this publication does not imply, even in the absence
of a specific statement, that such names are exempt from the relevant protective laws and regulations
and therefore free for general use.
Product Liability: The publisher can give no guarantee for information about drug dosage and applica
tion thereof contained in this book. In every individual case the respective user must check its accuracy
by consulting other pharmaceutical literature.
Typesetting: K+V Fotosatz GmbH, D-6124 Beerfelden
2125/3130-543210
Preface
It might appear bold to publish the proceedings of yet another sym
posium on the diagnosis and management of stroke. However, I hope in
selecting topics to reflect 'new trends' and in inviting speakers to discuss
these trends and the related concepts and results, that we have been suc
cessful in attaining a high level of scholarship as well as in appealing to
a wide readership.
The central issues here derive from a new typology of strokes that
should replace the obsolete distinction based on purely temporal param
eters so aptly criticized by Caplan. A classification of strokes on the
basis of pathogenesis requires a synopsis of information gained from
history, neurological and cardiovascular findings, ultrasound studies (ex
tracranial as well as transcranial), correctly timed CT scan investigation
and, if necessary, from selective angiography. Only the recognition of the
role of pathogenetic events for a patient permits the application of a ra
tional therapy regimen.
The spectrum of therapy programs ranges from hypervolemic or
isovolemic hemodilution, which is indicated by hematological data, to
early anticoagulation that has been demonstrated to be safe even in the
presence of an ischemic brain lesion. Local intra-arterial fibrinolysis of
acute arterial occlusion has proved most beneficial in hindbrain circula
tion and is applicable also in selected cases of acute occlusion of the
proximal segments of the middle cerebral artery. Monitoring of electro
physiological parameters and of arterial perfusion by means of ultra
sound techniques is mandatory in these instances. The exact place of
calcium entry blockers has yet to be determined. These appear to be very
promising agents not only in the early phase after SAH but possibly also
in acute ischemic stroke.
A view into the future is provided by contributions on new relatively
clot-specific substances with tissue plasminogen activating properties.
The many problems involved in this therapeutic approach are probably
not yet generally recognized. Selection of patients with angiographically
demonstrated acute occlusion of one or more major vessels that explains
the patients' signs and symptoms must be achieved; establishment of the
proper dosage will be very critical.
Surgical treatment and percutaneous intraluminal angioplasty have
not been covered in this symposium, for the emphasis here is on acute
stroke, for which these approaches, in spite of their general merit, are
rarely if ever employed.
Aachen, October 1987 KLAUS POECK
Acknowledgement
The organizers of the International Symposium on Trends in Diagnosis
and Management of Stroke wish to express their gratitude to Bayer AG,
Germany, for their generous support which made the organization of the
symposium and publication of the proceedings possible.
Contents
Part I: Diagnosis and Pathogenesis of Stroke
Transcranial Doppler Sonography
E. B. RINGELSTEIN (With 15 Figures). . . . . . . . . . . . . . . . . . . . . . . . 3
Indium-lll Platelet Scintigraphy in Stroke Patients
C. KESSLER (With 6 Figures) .............................. 29
Platelet Scintigraphy of the Carotid Arteries: Comparison with
the Histology of Thromboendarterectomy Specimens
H. HENNINGSEN (With 7 Figures) .......................... 47
Thrombosis and Cerebrovascular Disease
W. HACKE, G. J. DEL ZopPO, and L. A. HARKER
(With 1 Figure) .......................................... 59
Computed Tomography Patterns of Brain Infarctions as a
Pathogenetic Key
H. ZEUMER and E. B. RINGELSTEIN (With 4 Figures). . . . . . . . . . 75
Part II: Therapeutic Concepts in Stroke Patients
Platelet Inhibitors and the Prevention of Stroke
H. J. KRZYWANEK and H. K. BREDDIN (With 1 Figure) . . . . . . . . 89
Anticoagulants in the Treatment of Stroke
J. MARSHALL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Risk and Benefit of Anticoagulation in Patients with Acute
Hemispheric Infarctions: Preliminary Results
of a Prospective Study
G. KORBMACHER and E.B. RINGELSTEIN (With 4 Figures)..... 103
tPA and scuPA: New Concepts in the Treatment of
Acute Stroke
G. J. DEL ZopPO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Calcium Antagonists and Other Cerebroprotective Drugs
J. KRIEGLSTEIN, G. W. BIELENBERG, and H.-J. STIERSTORFER
(With 2 Figures). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
VIn Contents
Effect of Nimodipine on the Cerebral Circulation and Acute
Ischemic Stroke
H. 1. GELMERS, 1. H. A. WIEZER, C.l. DE WEERDT, and
K. GORTER (With 1 Figure).. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135
Closing Remarks
1. MARSHALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Contributors
G. W. BIELENBERG, Institute of Pharmacology and Toxicology, FB 16,
Philipps-University, Ketzerbach 63, D-3550 Marburg, FRG
H. K. BREDDIN, Department of Internal Medicine, Division of
Angiology, J. W. Goethe-University Hospital, Theodor Stern Kai 7,
D-6000 Frankfurt/Main 70, FRG
G. J. DEL ZOPPO, Department of Basic and Clinical Research, Scripps
Clinic and Research Foundation, 10666 North Torrey Pines Road,
La Jolla, CA 92037, USA
H. J. GELMERS, Department of Neurology, Streekziekenhuis Almelo,
NL-Almelo, The Netherlands
K. GORTER, Department of Neurology, St. Anatonius Ziekenhuis,
NL-Sneek, The Netherlands
W. HACKE, Department of Neurology, University of Heidelberg, Kopf
klinikum, 1m Neuenheimer Feld 400, D-6900 Heidelberg, FRG
L. A. HARKER, Department of Basic and Clinical Research, Scripps
Clinic and Research Foundation, 10666 North Torrey Pines Road,
La Jolla, CA 92037, USA
H. HENNINGSEN, Department of Neurology, University Hospital,
Voss-StraI3e 2, D-6900 Heidelberg 1, FRG
C. KESSLER, Department of Neurology, Krankenhaus Merheim,
Ostmerheimerstr. 200, D-5000 Kaln 91, FRG
GABRIELE KORBMACHER, Department of Neurology, Klinikum RWTH,
University Hospital, D-5100 Aachen, FRG
J. KRIEGLSTEIN, Institute of Pharmacology and Toxicology, FB 16,
Philipps-University, Ketzerbach 63, D-3550 Marburg, FRG
H. J. KRZYWANEK, Department of Internal Medicine, Division of
Angiology, J. W. Goethe-University Hospital, Theodor Stern Kai 7,
D-6000 Frankfurt/Main 70, FRG
J. MARSHALL, Institute of Neurology, National Hospital for Nervous
Diseases, Queen Square, London WC 1 N 3 BG, UK
X Contributors
E. B. RINGELSTEIN, Department of Neurology, Klinikum RWTH,
University Hospital, D-5100 Aachen, FRO
H.-J. STIERSTORFER, Institute of Pharmacology and Toxicology, FB 16,
Philipps-University, Ketzerbach 63, D-3550 Marburg, FRO
C.J. DE WEERDT, Scheper Ziekenhuis, NL-Emmen, The Netherlands
J. H. A. WIEZER, St. Elisabeth Ziekenhuis, NL-Venray, The Netherlands
H. ZEUMER, Department of Neurology, University-Hospital Eppen
dorf, University of Hamburg, D-2000 Hamburg
Part I
Diagnosis and Pathogenesis of Stroke