Stroke revisited : diagnosis and treatment of ischemic stroke

377 Pages·2017·13.68 MB·English

by  Lee

Seung-Hoon Lee Editor
Stroke Revisited:
Diagnosis and
Treatment of
Ischemic Stroke
Stroke Revisited
This authoritative book series presents state of the art knowledge on the
pathophysiology, prevention, diagnosis, and treatment of stroke, highlighting
the many very important advances that have been achieved in recent years.
Current issues in management are addressed in detail, equipping readers with
an understanding of the rationale for particular approaches in different
settings and with a sound knowledge of the role of modern imaging methods,
surgical techniques, and medical treatments. The inclusion of numerous
high- quality illustrations facilitates understanding of practical aspects and
rapid retrieval of fundamental information. The series will be of value for
stroke physicians, surgeons, other practitioners who care for patients with
stroke, and students.
More information about this series at http://www.springer.com/series/15338
Seung-Hoon Lee
Editor
Stroke Revisited:
Diagnosis and
Treatment of Ischemic
Stroke
Editor
Seung-Hoon Lee
Department of Neurology
Seoul National University Hospital
Department of Neurology
Seoul, South Korea
Stroke Revisited
ISBN 978-981-10-1423-9 ISBN 978-981-10-1424-6 (eBook)
DOI 10.1007/978-981-10-1424-6
Library of Congress Control Number: 2017949357
© Springer Science+Business Media Singapore 2017
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Preface
The most frequently used starting sentence in books or articles on stroke is:
“stroke is a disease ranked 4th in worldwide mortality, and 1st in worldwide
adult disabilities.” Although I am personally sick of using this sentence and
no longer use it when writing an article or a paper, there are still tons of
papers and books that start with this sentence. Why is that? Do the readers not
know the significance? Or is it to provide the readers with self-esteem, in that
the disease you are reading about and treating is extremely important? Maybe
both. Unfortunately, the importance of the disease is not emphasized enough
or recognized by the public, probably due to the modesty of the clinicians and
researchers treating and studying stroke. In most countries, both the patients
and the medical staff have very low awareness of stroke compared to heart
diseases, and the sizes of both the clinical and research workforce for stroke
are incomparably small. The stroke unit is sometimes a part of the department
of neurology and sometimes a part of internal medicine and rarely an inde-
pendent department in many countries. Considering the severity and impor-
tance of the disease, this system is too inconsistent and insufficient. In
addition to developing an integrated and systematic treatment protocol for
stroke, the presence of a textbook that provides up-to-date knowledge and
standard of treatment is essential.
I once had a meeting with the director of cardiovascular medicine in one
of the biggest multinational pharmaceutical companies in the world. The
director of the Europe-based company was an impressive, old, Caucasian
madam. She said that the stroke department in her company was being man-
aged entirely by the cardiovascular department. The meeting was held so that
I could provide advice on research and development (R&D) in medications
on stroke. Then, I was really puzzled about her lack of background knowl-
edge on stroke. She graduated from a recognized medical school in Europe
and practiced as a medical doctor in the cardiovascular division of the depart-
ment of internal medicine. How could she know so little about stroke? She
thought that stroke was simply another coronary artery disease that occurred
in the brain, and I was the first person to tell her about stroke due to small
vessel occlusion—which is an important subtype of stroke. Considering the
fact that the head of R&D from a leading pharmaceutical company barely
knew anything about stroke, it is not a surprise to see no medication or unsuc-
cessful medication being developed for stroke treatment. Even now, I believe
that the situation has not changed. If there was a textbook that provides a
v
vi Preface
simple explanation of stroke and discusses the key differences between stroke
and heart diseases, would the situation be any different?
Actually, there are not many textbooks that explain stroke in detail. During
my residency and fellowship, there were only two or three books that I could
read to study stroke. Even these books were not enough to fully appreciate the
advancement in stroke treatment during 1990–2000. Brain imaging dramati-
cally improved the quality of treatment by allowing immediate recognition of
the continuously changing pathophysiology of the stroke patient. Nevertheless,
majority of textbooks contain a big portion explaining outdated neurological
examinations, providing no support for development in the practical field.
Furthermore, most textbooks simply outlined the results from various studies
and did not focus on helping readers to understand the key concepts or pro-
viding appropriate schemes for treatment protocols. Although the situation
was probably similar for other fields, studying stroke during this period
required extensive patience.
Recent development of smartphones and tablets allowed international
communications through social media, and people now have access to exten-
sive amount of information. Textbooks to deliver medical knowledge should
also change to reflect the rapidly advancing modern technology and must
focus on providing simple and clear explanations of key concepts. The con-
tent of each chapter should be minimized, and visual diagrams should be
utilized to help the readers better understand key concepts. Listing unneces-
sary results from studies should be avoided, while standard treatment guide-
lines from various academic societies would be better to be collated and
described. I decided to write such a textbook reflecting these changes and
contacted Springer Nature. Springer Nature was very helpful and planned a
new series of textbooks entitled Stroke Revisited. There are many difficulties,
such as language barriers, for a Korean to contact a European publisher to
plan and publish a series of textbooks. I would like to sincerely thank Springer
Nature and its employees for their assistance in the publication of this
textbook.
The target readers of this textbook are trainees such as residents and fel-
lows, specialists in their early careers specializing in stroke treatment, and
doctors and researchers from various fields who wish to understand stroke in
more depth. Most individual chapters have a single focus and have minimal
text so that it is convenient to read the entire chapter in a short period of time.
Unnecessary text was not included, and the use of visual aids was maximized.
Only the essential reference literature has been included. The key character-
istic of this textbook is the presentation of treatment procedures in sequence,
starting at the initial admission of stroke patient in the emergency room, diag-
nosis, treatment, up to discharge and/or preventive measures. Most textbooks
are organized in the traditional literature form. Therefore, in practice, sorting
and selecting the section to obtain the knowledge from is difficult and time- -
consuming. This textbook attempts to simulate the actual practice, providing
simultaneous explanation of diagnosis and treatment. At the same time,
I tried to provide the highest quality of academic depth and up-to-date infor-
mation on stroke. I hope the readers can fully benefit from these efforts.
Preface vii
In order to ensure that this textbook provides cutting-edge, yet authorita-
tive and reliable, knowledge on stroke, experts from different parts of the
world were invited to write each chapter. I would like to thank all the authors
who participated in writing this textbook. This textbook is the first part of the
Stroke Revisited series, and I hope it provides a flavor for the parts to follow.
2017.1.17 Seung-Hoon Lee, M.D., Ph.D., F.A.H.A.
How to Read
To give readers practical information on stroke management, I tried to orga-
nize this book with a different style from conventional academic books. First,
assuming that the readers are duty doctors in emergency units, the parts and
chapters in this book were organized as time sequence after visit of stroke
patients. Part I covers the establishment and organization of stroke units and
centers, and Part II comprehensively describes the diagnosis and treatment of
ischemic stroke in acute stage. Part III gives cutting-edge knowledge on cer-
tain but relatively frequent causes, and secondary prevention after stroke was
fully illustrated in Part IV. Part V covering clinical practice guidelines, which
play a critical role in current medical practice, delineates their history, useful-
ness, and disadvantages and suggests my improvement direction of the guide-
lines. In particular, Chap. 4 in Part II entitled “Overview of Patient
Management Flow” summarizes contents of diagnosis and management in
stroke unit, general ward, and rehabilitation center and indicates correspond-
ing chapters with more detailed information. Accordingly, if you choose to
read a chapter among them, you will easily find to learn its position from the
whole stroke management flow. Second, if you read abstract in the beginning
of each chapter, you can easily obtain essential summary of the whole content
of the chapter. Third, I tried to provide a simple but conceptual diagram cov-
ering all aspects of contents as a figure in each chapter. You just look into the
diagram, and you will find the essential points of the chapter. Finally, there
are “suggestions from current clinical practice guidelines” in the final part of
each chapter. This part briefly summarizes essential recommendations of
clinical practice guidelines in the world, especially from the American
Heart Association/American Stroke Association. Thus, you can easily get
up-to- date recommendations and notice information gaps between cutting- -
edge knowledge and current guidelines.
As stated in the preface, I tried to convey real, practical, but cutting-edge
knowledge of stroke management with the unique organization style.
However, this book is not a manual nor a protocol on stroke management.
This is because top-class authors in the world gathered together to organize
the most up-to-date knowledge. I hope that this book will be a guide to better
understanding of stroke, which is a better way to deal with stroke patients.
Seung-Hoon Lee, M.D., Ph.D., F.A.H.A.
ix
Acknowledgments
Although I had an ideal model for a textbook in my brain, I rarely had an
active conversation with publishers about my idea. This textbook was con-
ceived in an e-mail proposal of the textbook after an unplanned meeting with
Ms. Lauren Kim, the editor of Springer Nature. The editorial team and I have
obtained manuscripts from renowned medical experts in the world and have
edited the manuscripts according to the principles we have set for this text-
book. Therefore, the contents of this book were completed only after tremen-
dous efforts from the editorial team. I would like to thank Dr. Jung Min Kim,
Dr. Tae-Jung Kim, and Ms. Eun-Sun Park for their effort in the editorial team.
In addition, I would like to thank the executive members of edition who
agreed with the philosophy behind this textbook and provided the title for this
textbook series—Stroke Revisited—in addition to providing active support in
publishing this book. Finally, I would like to thank the Cerebrovascular
Research Society in Korea and its members for their financial and technical
support.
Throughout my research career, I focused on publishing papers as an
author and becoming a famous, prosperous scientist. I rarely thought of writ-
ing a textbook. I would like to express my love towards my wife, my children,
and my family, for changing my selfish thoughts and helping me understand
my responsibilities, that is, to help others and provide education to nurture
future doctors.
2017.1.17 Seung-Hoon Lee, M.D., Ph.D., F.A.H.A.
xi