Oxford textbook of stroke and cerebrovascular disease

306 Pages·2014·34.37 MB·English

by  Norrving

Oxford Textbook of
Stroke and
Cerebrovascular
Disease
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Oxford Textbook of
Stroke and
Cerebrovascular

Disease
Edited by
Bo Norrving
Professor in Neurology
Department of Clinical Sciences
Section of Neurology
Lund University
Lund, Sweden
Series Editor
Christopher Kennard
1
3

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Foreword

Stroke has always been a worldwide problem, but only now is it on the increasingly recognized areas of silent infarcts and micro-
being recognized as a global, treatable, and preventable condition, bleeds, vascular cognitive impairment and dementia, and the
largely through scientifi c advances and the work of stroke leaders long-term management of stroke. As a former President of the
such as the contributors to this volume. World Stroke Organization, the editor has led eff orts to put stroke
Knowledge accrues in pieces but is understood in patterns. Th e at the forefront of global health policy by working with the World
internet has made information available in unprecedented quanti- Health Organization and the United Nations. Th is enlarged vision
ties, but of uneven value. Bits and bytes of information are but a of stroke is refl ected in a chapter on primary stroke prevention and
few clicks away. However, these pieces have to be put in patterns, in one on healthcare services, topics that do not usually feature in
context, and we need to recognize the fact that we still know much books on stroke.
less than we need to know, hence the need for a comprehensive, May this book enjoy the broad readership that it deserves.
credible, and accessible book.
B o Norrving and his international cast of authors off er such a Vladimir Hachinski, CM, MD, FRCPC, DSc,
volume. In addition to the usual chapters on anatomy, pathophysi- Dr. honoris causa X5
ology, diagnosis, treatment, and rehabilitation, there are chapters President, World Federation of Neurology

Preface

Stroke is huge by any measure: oft en cited data from the Global R eaders of this preface need not be told in detail what has hap-
Burden of Disease project are that there are 6 million deaths due pened during the last few decades: the introduction of acute
to stroke per year worldwide, 15 million cases of stroke per year, neuroimaging and other diagnostic tools, the demon stration
and 30 million persons who have survived a stroke. Other stroke of acute thrombolytic therapy as one of medicine’s best buys, the
measures are one new stroke every other second, every sixth sec- glory of organized stroke care (including early mobilization), the
ond stroke kills someone, and one in six will have a stroke during development of secondary prevention strategies that have changed
their lifetime. Such numbers have diff erent meanings to diff er- the prognosis aft er stroke d rastically, and the demonstration that
ent stakeholders. For the patient who has developed a stroke, and rehabilitation works—just to mention a few of the groundbreaking
for the carers, such data are of little interest (more than possibly changes that have taken place. Th ere has also been an avalanche
telling that ‘you are in good company, welcome to the club’)— of knowledge of mechanisms, causes, unusual features, stroke
my own stroke is more than enough for me. For health person- subtypes, and genetics. Advances in science have had a profound
nel the fi gures are more alarming: how can we take good care of impact on clinical practice in stroke.
so many patients, do we have the beds at the stroke unit (and is Another major change is a focus on stroke prevention through
there a stroke unit at all?), are there rehabilitation and follow-up joint actions with other non-communicable diseases (NCDs)
resources available? Who can do the job, who have the right edu- that share similar risk factors. Stroke is not acting alone in this
cation and competence? For health administrators, healthcare movement, but is part of the NCD cluster that has rightfully
planners, and politicians the numbers should be alarming: what received high governmental attention during the last few years.
are the precise numbers in my country or region? What is the Stroke shares many risk factors with heart disease, peripheral
trend? What can be done (and what can I do) to help and to pre- vascular disease, cancer, dementia, and pulmonary disease—just
vent stroke? And, will the numbers aff ect the fi nancial situation in to mention a few members of the NCD family.
my community? Th e World Stroke Organization emphasizes three pillars in the
Fortunately the stroke scene is changing—the Cinderella tale Global Agenda for Stroke: prevention, acute care, and long-term
being a good analogy of what has happened. Only a few decades management. Th e latter component has been particularly neglected
ago (when I started in neurology as my fi rst summer job) stroke and warrants much more attention in the future. Few areas in medi-
had the lowest priority at the emergency department because cine have such broad outreach, involve so many sectors of health-
there was no hurry and nothing could be done acutely. Stroke care, and have such a profound infl uence on public health as stroke.
units were unheard of—at my local hospital there was even a For this book I have had the privilege of working together with
hospital agreement by which patients who were impossible to many of today’s most outstanding stroke scientists. I am grateful to
rehabilitate (defi nition: age 65 years and above) were outsourced all of you for sharing your deep knowledge, and for making your-
to various other departments (dermatology, renal disease, oncol- selves available for the task. I take this opportunity to thank you all
ogy . . . ) so that the burden of stroke to the hospital could be most warmly for your contributions to this volume. I also thank
shared. Patients used to stay in bed for 1–2 weeks before any the very large number of people in the scientifi c stroke community,
mobilization took place. Heparin treatment was widely used within the World Stroke Organization and regional stroke organiza-
to prevent or treat progressing stroke whereas antiplatelets and tions, who have provided me with inspiration for the present work.
statins were unknown at that time. Carotid surgery was per- I would also like to thank the staff at Oxford University Press
formed by thoracic surgeons with rates of serious complication for expert help and support in making this book available. My
well above 10%. Any ultra-early therapy was regarded as doomed thanks go to Peter Stevenson who set me the task initially, to Eloise
to fail since science told us that brain cells could not survive more Moir-Ford for keeping track of all manuscript versions and chapter
than 5–10 minutes of ischaemia. Looking back, I have some diffi - status, to Papitha Ramesh and Nic Williams for copy editing, and
culties understanding why stroke nevertheless caught my interest to the many other people at Oxford University Press who have been
and attracted me. involved with this book. It has been a pleasure working with you.
viii preface
F inally, my thanks to my wife Lena and my three children (David, Only at the latter stage has a textbook like this one served its ulti-
Marcus, and Maria) for having been (quite) tolerant of the intru- mate purpose.
sion of my out-of-usual-business-hours’ work into family pleasures
and duties. Bo Norrving
I t is my hope that the book will be read, will be disseminated Lund, Sweden
broadly, and will fi nally lead to benefi ts for patients and carers. October 2013