Cerebral Ischemia

Despite a worldwide reduction in its incidence, stroke remains one of the most common diseases generally and the most important cause of premature and persistent disability in the industrialized countries. The most frequent cause of stroke is a localized disturbance of cerebral circulation, i.e., cerebral ischemia. Less common are spon taneous intracerebral and subarachnoid hemorrhages and sinus ve nous thromboses. The introduction of new diagnostic procedures such as cranial computed tomography, magnetic resonance imaging, digi tal subtraction radiologic techniques, and various ultrasound tech niques has led to impressive advances in the diagnosis of stroke. Through the planned application of these techniques, it is even possible to identify the pathogenetic mechanisms underlying focal cerebral ischemia in humans. However, these diagnostic advances have made the gap between diagnostic accuracy and therapeutic implications even greater than before. This fact can be easily explained. In the past, therapeutic studies had to be based on the symptoms and temporal aspects of stroke; it was impossible for early investigations to consider the various pathogeneses of cerebral ischemia. Inevitably, stroke patients were treated as suffering from a uniform disease.

Klappentext

This book covers the different causes of cerebral ischemia on the basis of information gained from new diagnostic techniques, in particular ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography. Various treatment possibilities are considered based on the differential analysis of topical anatomy and the dynamic aspects of the clinical phenomena. This approach is preferable to the conventional stage classification of stroke development because it reveals the individual pathomechanisms involved - e.g., hemodynamic and thromboembolic causes, macro- and microangiopathies, marginal flow and lacunar infarcts - and leads to the appropriate forms of treatment. With this in mind, the relevant anatomic and physiologic aspects of the cerebral circulation and the development of ischemia are discussed. The book also provides a comprehensive description of the clinical syndromes and modern diagnostic techniques and critically examines the current status of treatment.

Inhalt
1 Applied Anatomy of the Cerebral Arteries.- 1.1 Extracranial Anatomy.- 1.2 Intracranial Anatomy.- 1.3 Collaterals and Anastomoses.- 1.4 Arterial Anatomy and Infarct Types.- References.- 2 Pathophysiology of Cerebral Ischemia.- 2.1 Introduction.- 2.2 General Aspects of Brain Cell Metabolism.- 2.3 Regulation of Cerebral Circulation.- 2.4 Cerebral Ischemia.- 2.5 Ischemic Cerebral Edema.- References.- 3 Epidemiology and Classification of Strokes.- 3.1 Epidemiology.- 3.2 Definitions and Classification of Strokes.- References.- 4 Clinical Syndromes, Pathogenesis, and Differential Diagnosis.- 4.1 Symptoms and SyndromesTemporal and Topical Aspects.- 4.2 Pathogenetic Aspects.- 4.3 Special Types.- 4.4 Differential Diagnosis.- 4.5 Thrombosis of Cerebral Venous Sinuses.- References.- 5 Diagnosis.- 5.1 History and Clinical Findings.- 5.2 Ultrasound Diagnosis.- 5.3 Computer-Assisted Imaging Techniques.- 5.4 Electrophysiologic Investigations.- 5.5 Cerebral Angiography.- References.- 6 Treatment and Prophylaxis.- 6.1 General Treatment.- 6.2 Special Treatment in the Acute Phase.- 6.3 Prophylaxis of Cerebral Ischemia.- 6.4 Rehabilitation in Cerebrovascular Diseases.- References.