Stroke Essentials for Primary Care (eBook)

A Practical Guide

David Alway, John Walden Cole (Herausgeber)

eBook Download: PDF

2009 | 2009
XII, 204 Seiten
Humana Press (Verlag)
978-1-59745-433-9 (ISBN)

Infos

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.

Inhalt

Series Editor Introduction 6
Preface 8
Contents 9
Contributors 11
Identifying Stroke and Stroke Type 13
Identifying Stroke 13
Typical Symptoms/Signs of Ischemic Stroke and Transient Ischemic Attack 14
Typical Signs/Symptoms of Intracerebral Hemorrhage 16
Typical Signs/Symptoms of Subarachnoid Hemorrhage 17
Typical Signs/Symptoms of Cerebral Venous Sinus Thrombosis 20
Ischemic Stroke and Transient Ischemic Attack - Acute Evaluation and Management 21
Pathophysiology of Ischemic Stroke 21
Early Stroke Recognition and Identification of Stroke Type 22
Stroke Recognition by the Community 23
Stroke Recognition in the Emergency Room 23
Ischemic Stroke Types 24
Anterior Cerebral Artery (ACA) 24
Middle Cerebral Artery (MCA) 24
Posterior Cerebral Artery (PCA) 25
Basilar Artery (BA) and Vertebral Arteries (VA) 26
Lacunar Syndromes 26
A Word About Tissue Plasminogen Activator (tPA) 27
Emergency Department Management of Ischemic Stroke 28
Rapid Testing 28
The NIH Stroke Scale 29
Deciding Whether to Administer IV tPA 30
Caveats and Special Considerations 30
Beyond the 3-h Time Frame 31
Inpatient Care 32
Blood Pressure 32
IV Fluids 33
Glucose 33
Anticoagulation 33
Platelet Inhibition 34
Preventing and Treating Stroke Complications 35
Deep Venous Thrombosis (DVT) 35
Infection Prevention and Treatment 35
Cerebral Edema 35
Hemorrhagic Transformation 36
In-Patient Testing for Stroke/TIA Etiology 36
Beginning Preventative Treatment in the Hospital 38
Hypertension 38
Atrial Fibrillation 38
Carotid Artery Stenosis 39
Hyperlipidemia 39
Smoking Cessation 39
Antiplatelet Medication 40
Conclusion 40
Brief Summary 40
References 43
Ischemic Stroke and Transient Ischemic Attack: Long-Term Management and Secondary Prevention 46
Introduction 46
Traditional Risk Factors 54
Emerging Risk Factors and Special Considerations 57
Medical Therapy 60
Surgical Therapy 63
Lifestyle Interventions 63
References 64
Intracerebral Hemorrhage: Acute Evaluation and Management 68
Presenting Signs and Symptoms 68
Diagnostic Testing 68
Etiology/Pathophysiology 69
Treatment 70
General Measures 70
Bleeding Disorders 70
Blood Pressure 71
Fever 71
Hyperglycemia 71
Seizure Prophylaxis 71
Surgical Intervention for Hematoma Evacuation 72
Cerebellar Hemorrhages 72
Supratentorial Hemorrhages 72
Controversial Interventions 73
ICH Complications and Their Treatments 73
Hematoma Enlargement 73
Edema Formation 73
Hydrocephalus 74
Increased Intracranial Pressure 74
Seizures and Status Epilepticus 75
Isolated Seizure 76
Status Epilepticus 76
Herniation Syndromes 76
Secondary Infarcts 77
Brief Summary 77
References 78
Intracerebral Hemorrhage: Long-Term Complications and Prevention 80
Introduction 80
Outcome After Intracerebral Hemorrhage 80
Early Deterioration After Intracerebral Hemorrhage 81
Neurologic and Medical Complications After Intracerebral Hemorrhage 81
Recurrent Intracerebral Hemorrhage 82
Risk of Ischemic Stroke 83
Antiplatelet Use After Intracerebral Hemorrhage 83
Anticoagulant Use After Intracerebral Hemorrhage 84
Primary Prevention of Intracerebral Hemorrhage 84
Secondary Prevention of Intracerebral Hemorrhage 85
Conclusion 85
References 86
Subarachnoid Hemorrhage: Diagnosis and Acute Management 91
Basic Concepts 91
Definition 91
Background 91
Presenting Symptoms and Signs 92
Clinical Presentation 92
Headache 93
Signs of Meningeal Irritation 94
Changes in the Level of Consciousness 94
Focal Neurological Manifestations 95
Seizures 95
Fever 95
Intraocular Hemorrhages and Papilledema 96
Etiologies (Table 6.3) 96
Ruptured Saccular Aneurysm 96
Isolated Perimesencephalic SAH 98
Arteriovenous Malformations (AVM) 98
Coagulopathies 99
Vasculitides 99
Diagnostic Testing (Table 6.4) 99
Management 104
General Management 106
Treatment of the Cause of SAH 108
Recognition and Management of Complications of SAH 108
Rebleeding 108
Vasospasm 109
Hydrocephalus 110
Seizures 110
Cardiovascular Complications 110
Electrolyte Imbalances 110
References 111
Subarachnoid Hemorrhage: Long-Term Complications and Prevention 116
Introduction 116
Long-Term Outcome and Complications 117
Outcome in SAH 117
Long-Term or Delayed Complications 117
Rebleeding 117
Hydrocephalus 118
Epilepsy 119
Physical Impairments 119
Cognitive Impairments 119
Behavioral and Occupational Issues 120
Prevention 121
Modifiable Risk Factors 121
Hypertension 121
Smoking 121
Excessive Alcohol Intake 122
Other Potentially Modifiable Factors 122
Management of Patients with Incidentally Found Aneurysm (Without a History of SAH) 122
Genetic Issues 123
Aneurysm Screening in Primary and Secondary Prevention 124
Screening for Aneurysms in the Early Phase After SAH 124
Screening for Newly Formed Aneurysms Late After SAH 124
Screening for Aneurysms in First-Degree Relatives of SAH Patients 125
Screening for Aneurysms in Patients who have a Medical Condition Known to be Associated with SAH 125
Recommendations for General Follow up After SAH 126
References 126
Part 1: Special Topics 130
Ischemic Stroke in Young Adults 131
Introduction 131
The Approach to the Young Patient with Possible Ischemic Stroke 131
Mimics of Ischemic Stroke 131
Considerations for the Young Patient with Proven Ischemic Stroke 132
Overview of Causes of Ischemic Stroke in Young Adults [6] 139
Special Topics 140
Patent Foramen Ovale (PFO) 140
Dissection of the Carotid or Vertebral Arteries 141
Hypercoagulable Disorders 142
CNS Vasculitis [38, 39] 145
Cerebral Venous Thrombosis [41] 146
Stroke in Pregnancy and the Puerperium 147
Migraine and Stroke 149
Intracranial Hemorrhage 149
Bulleted Summary 149
References 151
Headache and Stroke 155
Introduction 155
Headache Epidemiology 155
Some General Considerations: Evaluation and Workup 156
Evaluation 156
Workup 157
Headache as a Symptom of Stroke 160
Hemorrhagic Stroke 160
Ischemic Stroke 161
Headache as a Risk Factor for Stroke 162
References 164
Hypercoagulable States and Stroke 167
Introduction 167
Pathophysiology 167
Presenting Signs and Symptoms 168
Etiology 168
Primary Hypercoagulable States 169
Hereditary Hypercoagulable Disorders 169
Antiphospholipid Antibody (aPL) Syndrome 169
Sickle Cell Disease (SCD) 170
Hyperhomocystinemia 170
Secondary Hypercoagulable States 170
Diagnostic Testing 171
Prothrombin Time (PT) 171
Partial Thromboplastin Time (aPTT) 171
Antiphospholipids (aPLs) 171
Protein C 172
Protein S 172
Antithrombin III 172
Genetic Test for Factor V Leiden and Prothrombin G20210A Mutation 172
Homocysteine 173
Hemoglobin Electrophoresis 173
Treatment 173
Hereditary Hypercoagulable Disorders 173
Antiphospholipid Antibody (aPL) Syndrome 174
Sickle Cell Disease 174
Hyperhomocysteinemia 175
Brief Summary 175
References 176
Carotid Artery Stenosis 178
Cerebral Vasculature and Stroke Location 179
Methods of Carotid Evaluation 180
Bedside Auscultation for Carotid Bruit 180
Carotid Artery Ultrasonography 180
Magnetic Resonance Angiography 181
Computerized Tomographic Angiogram (CTA) 181
Cerebral Angiography 182
Screening for Asymptomatic Carotid Stenosis 182
Timing of Carotid Artery Imaging for Symptomatic Carotid Artery Disease 182
Carotid Stenosis: Medical, Surgical, and Endovascular Management 183
Medical Therapy 183
Antithrombotic Therapy for Stroke and TIA Prevention: Carotid Artery Disease 183
Carotid Endarterectomy 184
Endovascular Angioplasty and Stenting 185
Patient Education 186
Brief Summary 187
References 188
Cerebral Venous Thrombosis 190
Introduction 190
Venous Sinus Anatomy 190
Clinical Syndromes 192
Lateral Sinus Thrombosis 192
Sagittal Sinus Thrombosis 192
Deep Venous Thrombosis 192
Etiologies 193
Diagnostic Procedures 194
Treatment Options 197
Less Established Treatment Options 197
General Care 198
Prognosis 198
Summary of Management 199
References 199
Index 200

Produkt-Details

• Erscheint lt. Verlag: 5.4.2009
• Reihe/Serie: Current Clinical Practice
• Reihe/Serie: Current Clinical Practice
• Zusatzinfo: XII, 204 p.
• Verlagsort: Totowa
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Allgemeinmedizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Themenwelt: Medizin / Pharmazie ► Pflege
• Schlagworte: Carotid Artery • Cerebral Venous Thrombosis • Hemorrhage • Hypercoagulable • Intracerebral • Ischemic • Neurology • stroke • Subarachnoid
• ISBN-10: 1-59745-433-8 / 1597454338
• ISBN-13: 978-1-59745-433-9 / 9781597454339