Alway / Cole Stroke Essentials for Primary Care

A Practical Guide
1. Auflage 2009
ISBN: 978-1-59745-433-9
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 204 Seiten

Reihe: Current Clinical Practice

Stroke Essentials for Primary Care: A Practical Guide is a must-have resource, offering the essential, practical knowledge required to evaluate and treat stroke patients. While an indispensable guide for primary care clinicians, including family practitioners and medical internists who often assume the care of stroke patients without the aid of a neurologist (primarily in underserved areas), the information contained herein is also an invaluable resource to all physicians in training, especially residents and fellows in neurology, cardiology, and surgery, among others. Stroke Essentials for Primary Care: A Practical Guide provides the latest diagnostic and treatment information that allows for greater clinical confidence. Designed to allow easy access to essential information, most chapters include a quick summary of their content and conclusions. Chapters review information on such topics as distinguishing features of presentation, rapid determination of stroke type, prevention strategies, long-term complications, and special topics that may apply to specific populations. Targeted and easy to read, Stroke Essentials for Primary Care: A Practical Guide is an essential resource for all practitioners in primary care medicine and specialty physicians in training.

Autoren/Hrsg.

Alway, David

Cole, John Walden

Inhaltsverzeichnis

1;Series Editor Introduction;6
2;Preface;8
3;Contents;9
4;Contributors;11
5;Identifying Stroke and Stroke Type;13
5.1;Identifying Stroke;13
5.2;Typical Symptoms/Signs of Ischemic Stroke and Transient Ischemic Attack;14
5.3;Typical Signs/Symptoms of Intracerebral Hemorrhage;16
5.4;Typical Signs/Symptoms of Subarachnoid Hemorrhage;17
5.5;Typical Signs/Symptoms of Cerebral Venous Sinus Thrombosis;20
6;Ischemic Stroke and Transient Ischemic Attack - Acute Evaluation and Management;21
6.1;Pathophysiology of Ischemic Stroke;21
6.2; Early Stroke Recognition and Identification of Stroke Type;22
6.2.1;Stroke Recognition by the Community;23
6.2.2;Stroke Recognition in the Emergency Room;23
6.2.3;Ischemic Stroke Types;24
6.2.3.1;Anterior Cerebral Artery (ACA);24
6.2.3.2;Middle Cerebral Artery (MCA);24
6.2.3.3;Posterior Cerebral Artery (PCA);25
6.2.3.4;Basilar Artery (BA) and Vertebral Arteries (VA);26
6.2.3.5;Lacunar Syndromes;26
6.2.4;A Word About Tissue Plasminogen Activator (tPA);27
6.3;Emergency Department Management of Ischemic Stroke;28
6.3.1;Rapid Testing;28
6.3.2;The NIH Stroke Scale;29
6.3.3;Deciding Whether to Administer IV tPA;30
6.3.4;Caveats and Special Considerations;30
6.3.5;Beyond the 3-h Time Frame;31
6.4;Inpatient Care;32
6.4.1;Blood Pressure;32
6.4.2;IV Fluids;33
6.4.3;Glucose;33
6.4.4;Anticoagulation;33
6.4.5;Platelet Inhibition;34
6.5;Preventing and Treating Stroke Complications;35
6.5.1;Deep Venous Thrombosis (DVT);35
6.5.2;Infection Prevention and Treatment;35
6.5.3;Cerebral Edema;35
6.5.4;Hemorrhagic Transformation;36
6.6;In-Patient Testing for Stroke/TIA Etiology;36
6.7;Beginning Preventative Treatment in the Hospital;38
6.7.1;Hypertension;38
6.7.2;Atrial Fibrillation;38
6.7.3;Carotid Artery Stenosis;39
6.7.4;Hyperlipidemia;39
6.7.5;Smoking Cessation;39
6.7.6;Antiplatelet Medication;40
6.8;Conclusion;40
6.9;Brief Summary;40
6.10;References;43
7;Ischemic Stroke and Transient Ischemic Attack: Long-Term Management and Secondary Prevention;46
7.1;Introduction;46
7.2;Traditional Risk Factors;54
7.3;Emerging Risk Factors and Special Considerations;57
7.4;Medical Therapy;60
7.5;Surgical Therapy;63
7.6;Lifestyle Interventions;63
7.7;References;64
8;Intracerebral Hemorrhage: Acute Evaluation and Management;68
8.1;Presenting Signs and Symptoms;68
8.2;Diagnostic Testing;68
8.3;Etiology/Pathophysiology;69
8.4;Treatment;70
8.4.1;General Measures;70
8.4.2;Bleeding Disorders;70
8.4.3;Blood Pressure;71
8.4.4;Fever;71
8.4.5;Hyperglycemia;71
8.4.6;Seizure Prophylaxis;71
8.4.7;Surgical Intervention for Hematoma Evacuation;72
8.4.7.1;Cerebellar Hemorrhages;72
8.4.7.2;Supratentorial Hemorrhages;72
8.4.8;Controversial Interventions;73
8.5;ICH Complications and Their Treatments;73
8.5.1;Hematoma Enlargement;73
8.5.2;Edema Formation;73
8.5.3;Hydrocephalus;74
8.5.4;Increased Intracranial Pressure;74
8.5.5;Seizures and Status Epilepticus;75
8.5.5.1;Isolated Seizure;76
8.5.5.2;Status Epilepticus;76
8.5.6;Herniation Syndromes;76
8.5.7;Secondary Infarcts;77
8.6;Brief Summary;77
8.7;References;78
9;Intracerebral Hemorrhage: Long-Term Complications and Prevention;80
9.1;Introduction;80
9.2;Outcome After Intracerebral Hemorrhage;80
9.3;Early Deterioration After Intracerebral Hemorrhage;81
9.4;Neurologic and Medical Complications After Intracerebral Hemorrhage;81
9.5;Recurrent Intracerebral Hemorrhage;82
9.6;Risk of Ischemic Stroke;83
9.7;Antiplatelet Use After Intracerebral Hemorrhage;83
9.8;Anticoagulant Use After Intracerebral Hemorrhage;84
9.9;Primary Prevention of Intracerebral Hemorrhage;84
9.10;Secondary Prevention of Intracerebral Hemorrhage;85
9.11;Conclusion;85
9.12;References;86
10;Subarachnoid Hemorrhage: Diagnosis and Acute Management;91
10.1;Basic Concepts;91
10.1.1;Definition;91
10.1.2;Background;91
10.2;Presenting Symptoms and Signs;92
10.2.1;Clinical Presentation;92
10.2.2;Headache;93
10.2.3;Signs of Meningeal Irritation;94
10.2.4;Changes in the Level of Consciousness;94
10.2.5;Focal Neurological Manifestations;95
10.2.6;Seizures;95
10.2.7;Fever;95
10.2.8;Intraocular Hemorrhages and Papilledema;96
10.3;Etiologies (Table 6.3);96
10.3.1;Ruptured Saccular Aneurysm;96
10.3.2;Isolated Perimesencephalic SAH;98
10.3.3;Arteriovenous Malformations (AVM);98
10.3.4;Coagulopathies;99
10.3.5;Vasculitides;99
10.4;Diagnostic Testing (Table 6.4);99
10.5;Management;104
10.5.1;General Management;106
10.5.2;Treatment of the Cause of SAH;108
10.6;Recognition and Management of Complications of SAH;108
10.6.1;Rebleeding;108
10.6.2;Vasospasm;109
10.6.3;Hydrocephalus;110
10.6.4;Seizures;110
10.6.5;Cardiovascular Complications;110
10.6.6;Electrolyte Imbalances;110
10.7;References;111
11;Subarachnoid Hemorrhage: Long-Term Complications and Prevention;116
11.1;Introduction;116
11.2;Long-Term Outcome and Complications;117
11.2.1;Outcome in SAH;117
11.2.2;Long-Term or Delayed Complications;117
11.2.3;Rebleeding;117
11.2.4;Hydrocephalus;118
11.2.5;Epilepsy;119
11.2.6;Physical Impairments;119
11.2.7;Cognitive Impairments;119
11.2.8;Behavioral and Occupational Issues;120
11.3;Prevention;121
11.3.1;Modifiable Risk Factors;121
11.3.1.1;Hypertension;121
11.3.1.2;Smoking;121
11.3.1.3;Excessive Alcohol Intake;122
11.3.2;Other Potentially Modifiable Factors;122
11.3.3;Management of Patients with Incidentally Found Aneurysm (Without a History of SAH);122
11.3.4;Genetic Issues;123
11.4;Aneurysm Screening in Primary and Secondary Prevention;124
11.5;Screening for Aneurysms in the Early Phase After SAH;124
11.5.1;Screening for Newly Formed Aneurysms Late After SAH;124
11.5.2;Screening for Aneurysms in First-Degree Relatives of SAH Patients;125
11.5.3;Screening for Aneurysms in Patients who have a Medical Condition Known to be Associated with SAH;125
11.6;Recommendations for General Follow up After SAH;126
11.7;References;126
12;Part 1: Special Topics;130
12.1;Ischemic Stroke in Young Adults;131
12.1.1;Introduction;131
12.1.2;The Approach to the Young Patient with Possible Ischemic Stroke;131
12.1.2.1;Mimics of Ischemic Stroke;131
12.1.3;Considerations for the Young Patient with Proven Ischemic Stroke;132
12.1.4;Overview of Causes of Ischemic Stroke in Young Adults [6];139
12.1.5;Special Topics;140
12.1.5.1;Patent Foramen Ovale (PFO);140
12.1.5.2;Dissection of the Carotid or Vertebral Arteries;141
12.1.5.3;Hypercoagulable Disorders;142
12.1.5.4;CNS Vasculitis [38, 39];145
12.1.5.5;Cerebral Venous Thrombosis [41];146
12.1.5.6;Stroke in Pregnancy and the Puerperium;147
12.1.5.7;Migraine and Stroke;149
12.1.6;Intracranial Hemorrhage;149
12.1.7;Bulleted Summary;149
12.1.8;References;151
12.2;Headache and Stroke;155
12.2.1;Introduction;155
12.2.2;Headache Epidemiology;155
12.2.3;Some General Considerations: Evaluation and Workup;156
12.2.4;Evaluation;156
12.2.5;Workup;157
12.2.6;Headache as a Symptom of Stroke;160
12.2.6.1;Hemorrhagic Stroke;160
12.2.7;Ischemic Stroke;161
12.2.8;Headache as a Risk Factor for Stroke;162
12.2.9;References;164
12.3;Hypercoagulable States and Stroke;167
12.3.1;Introduction;167
12.3.2;Pathophysiology;167
12.3.3;Presenting Signs and Symptoms;168
12.3.4;Etiology;168
12.3.4.1;Primary Hypercoagulable States;169
12.3.4.1.1;Hereditary Hypercoagulable Disorders;169
12.3.4.1.2;Antiphospholipid Antibody (aPL) Syndrome;169
12.3.4.1.3;Sickle Cell Disease (SCD);170
12.3.4.1.4;Hyperhomocystinemia;170
12.3.4.2;Secondary Hypercoagulable States;170
12.3.5;Diagnostic Testing;171
12.3.5.1;Prothrombin Time (PT);171
12.3.5.2;Partial Thromboplastin Time (aPTT);171
12.3.5.3;Antiphospholipids (aPLs);171
12.3.5.4;Protein C;172
12.3.5.5;Protein S;172
12.3.5.6;Antithrombin III;172
12.3.5.7;Genetic Test for Factor V Leiden and Prothrombin G20210A Mutation;172
12.3.5.8;Homocysteine;173
12.3.5.9;Hemoglobin Electrophoresis;173
12.3.6;Treatment;173
12.3.6.1;Hereditary Hypercoagulable Disorders;173
12.3.6.2;Antiphospholipid Antibody (aPL) Syndrome;174
12.3.6.3;Sickle Cell Disease;174
12.3.6.4;Hyperhomocysteinemia;175
12.3.7;Brief Summary;175
12.3.8;References;176
12.4;Carotid Artery Stenosis;178
12.4.1;Cerebral Vasculature and Stroke Location;179
12.4.2;Methods of Carotid Evaluation;180
12.4.2.1;Bedside Auscultation for Carotid Bruit;180
12.4.2.2;Carotid Artery Ultrasonography;180
12.4.2.3;Magnetic Resonance Angiography;181
12.4.2.4;Computerized Tomographic Angiogram (CTA);181
12.4.2.5;Cerebral Angiography;182
12.4.2.6;Screening for Asymptomatic Carotid Stenosis;182
12.4.2.7;Timing of Carotid Artery Imaging for Symptomatic Carotid Artery Disease;182
12.4.2.8;Carotid Stenosis: Medical, Surgical, and Endovascular Management;183
12.4.2.9;Medical Therapy;183
12.4.2.10;Antithrombotic Therapy for Stroke and TIA Prevention: Carotid Artery Disease;183
12.4.2.11;Carotid Endarterectomy;184
12.4.2.12;Endovascular Angioplasty and Stenting;185
12.4.2.13;Patient Education;186
12.4.3;Brief Summary;187
12.4.4;References;188
12.5;Cerebral Venous Thrombosis;190
12.5.1;Introduction;190
12.5.2;Venous Sinus Anatomy;190
12.5.3;Clinical Syndromes;192
12.5.3.1;Lateral Sinus Thrombosis;192
12.5.3.2;Sagittal Sinus Thrombosis;192
12.5.3.3;Deep Venous Thrombosis;192
12.5.4;Etiologies;193
12.5.5;Diagnostic Procedures;194
12.5.6;Treatment Options;197
12.5.6.1;Less Established Treatment Options;197
12.5.6.2;General Care;198
12.5.7;Prognosis;198
12.5.8;Summary of Management;199
12.5.9;References;199
13;Index;200