Current Review of Cerebrovascular Disease

258 Pages·2000·31.998 MB·English

by  Marc Fisher (ed.), Julien Bogousslavsky (ed.)

Current Review of
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Cerebrovascular
Disease
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Fourth Edition
Current Review of __
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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
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ISBN-13: 978-1-4684-0003-8 e-ISBN-13: 978-1-4684-0001-4
001: 10.1007/978-1-4684-0001-4
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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