Stroke (Biographies of Disease)

181 Pages·2008·3.31 MB·English

by  Jonathan A. Edlow

STROKE
RecentTitlesinthe
BiographiesofDiseaseSeries
Parkinson’sDisease
NutanSharma
Depression
BlaiseA.Aguirre
Diabetes
AndrewGalmer
STROKE
Jonathan A. Edlow
BiographiesofDisease
JulieK.Silver,M.D.,SeriesEditor
GREENWOODPRESS
Westport,Connecticut x London
Libraryof Congress Cataloging-in-Publication Data
Edlow, Jonathan A.
Stroke /Jonathan A.Edlow.
p. ;cm.—(Biographies ofdisease, ISSN 1940-445X)
Includes bibliographical references and index.
ISBN 978-0-313-34241-7(alk. paper)
1. Cerebrovascular disease. I.Title. II.Series.
[DNLM: 1.Stroke. WL355E23s2008]
RC388.5.E323 2008
616.801—dc22 2008004527
BritishLibrary Cataloguing inPublication Data isavailable.
Copyright (cid:2)C 2008byJonathan A. Edlow
Allrights reserved. Noportionof thisbookmay be
reproduced, byany process ortechnique, withoutthe
express written consentofthe publisher.
Library ofCongress Catalog Card Number:2008004527
ISBN:978-0-313-34241-7
ISSN:1940-445X
First publishedin 2008
Greenwood Press,88Post RoadWest,Westport, CT06881
An imprintofGreenwood PublishingGroup, Inc.
www.greenwood.com
Printedin theUnited States ofAmerica
Thepaper usedinthis bookcomplies with the
Permanent Paper Standardissued bythe National
Information StandardsOrganization (Z39.48–1984).
10 9 8 7 6 5 4 3 2 1
Contents
SeriesForeword ix
Preface xi
Chapter1. IntroductoryConceptsandDefinitions 1
Chapter2. PathophysiologyandRiskFactorsforStroke 11
EmbolicStrokeResultingfromHeartDisease 13
Atherosclerosis 14
GeneticFactors 16
ElevatedLipids 16
Small-VesselDisease 16
BloodCoagulation 17
HemorrhagicStroke 20
Chapter3. Symptoms:AmIHavingaStroke? 25
AbruptOnset 25
NeurologicalDysfunctioninaSingleArterialTerritory 26
DurationofSymptomsLastsGreaterthanTwenty-FourHours 26
SpecificSymptoms 27
vi Contents
Chapter4. DiagnosisofStroke 35
Chapter5. GeneralTreatmentofStroke 51
ABCs 51
BloodPressureControl 52
GuidelinesforElevatedBloodPressure 56
Temperature 56
PainandAnxiety 57
BloodSugar 57
StrokeCenters 58
Chapter6. SpecificTreatmentofIschemicStroke 63
Fibrinolytic(Thrombolytic)Treatment 63
FibrinolyticTreatmentBeyondThreeHoursfromOnsetof
Symptoms 70
AnticoagulationDrugTherapy 70
Anti-PlateletDrugTherapy 72
NeuroprotectiveAgents 72
Lipids 73
Chapter7. TreatmentofHemorrhagicStroke 75
GeneralIssues 75
Surgery 78
ProcoagulantMedications 79
InterventionstoReduceICP 80
AmyloidAngiopathy 80
HypertensiveBleed 81
Coagulopathy-AssociatedBleed 82
IntracranialAneurysm 83
AVMandOtherVascularAbnormalities 87
VenousSinusThrombosis 88
ArterialDissection 89
Vasculitis 90
SubduralandEpiduralHemorrhage 91
Chapter8. Long-TermOutcomes 93
Chapter9. PreventingStroke 101
LifestyleModifications 102
Hypertension(HighBloodPressure) 104
Diabetes 105
BloodLipids 107
Contents vii
AtrialFibrillation 108
OtherCardio-embolicSourcesofClot 110
Anti-PlateletMedications 110
AsymptomaticCarotidStenosis 111
ElevatedHomocysteineLevels 112
HypercoagulableStates 112
PFO 112
IntracranialAneurysm 113
PreventionofHemorrhagicStroke 116
Chapter10. TIA:AGoldenOpportunityatStrokePrevention 119
Chapter11. NewHorizons:BatsandSnakes 127
StrokeSystemsofCare 128
NewMedicalApproachestoStrokeTreatment 128
NewSurgicalandInterventionalEndovascularApproaches 135
Conclusions 139
Timeline 141
Glossary 147
Bibliography 157
Index 159
Series Foreword
E very killer has a story to tell, and so it is with diseases as well: about
how it started long ago and began to take the lives of its innocent vic-
tims, about the way it hurts us, and about how we are trying to stop it.
In this Biographies of Disease series, the authors tell the stories of the diseases
that wehave cometo knowand fear.
The stories of these killers have all of the components that make for great
literature. There is incredible drama played out in real-life scenes from the
past, present, and future. You’ll read about how men and women of science
stumbled trying to save the lives of those they aimed to protect. Turn
the pages and you’ll also learn about the amazing success of those who fought
the killer andwon, saving thousands oflives inthe process.
If you don’t want to be a health professional or research scientist now,
when you finish this book you may think differently. The men and women in
this book are heroes who often risked their own lives to save ours. This is the
biographyofakiller,butitisalsothe storyofreal peoplewhomadeincredible
sacrifices tostopit initstracks.
JulieK. Silver, M.D.
Assistant Professor, Harvard Medical School
Department ofPhysical Medicine and Rehabilitation
Preface
W hen I was in high school, my grandfather had a severe stroke. He
was a diabetic, and, in those days, the late 1960s, doctors did not
have their patients control their blood sugars very closely. Diabe-
tes was, and as the reader will see still is, an important risk factor for stroke.
His stroke was a scary thing for the family. He was hospitalized in a medium-
sized hospital in downtown Baltimore, close to where he worked but far from
where we lived. I remember my cousin Jay, a medical student at the time,
drove someofthe familyto the hospital.
At his bedside, although I knew no more about stroke than the average
high school student, I can recall three things. The first is that my grandfather
couldnotspeak,notevenasingleword.Thesecondisthathecouldnotmove
theright sideofhisbodyatall,but,whenIstoodonhisleft, hewould squeeze
my hand, strongly, with his left hand. I don’t know why I remember that, but
I do. The third memory is how devastating the stroke was for the family. It
was frightening to have a loved one who is normal one minute and literally
paralyzed andmutethe next.
Ididn’tknowthatIwasgoingtobecomeadoctor,norwasthisanydefining
moment of my adolescence. In fact, I haven’t thought of it for many years, but
the experience obviously left a mark. I think that the reason that the memory
comes to mind as I write this preface is that the real impact on society is the
humanimpactthatstrokeimpartsontoitsvictimsandtheirfamilies.