Silverman: Hemorrhagic Stroke: An Atlas of Investigation and Treatment

Hemorrhagic stroke has always been the poor sibling to its ischemic counterpart. Not only is hemorrhage much less common, but it also has significantly worse clinical outcomes, and relatively fewer emergent therapies. The reality that only about 20% of patients with a primary intracerebral hemorrhage (ICH, the most common type of major bleeding in the brain) survive to make an independent recovery should be a call to focus upon this important disease.
Hemorrhagic stroke is grabbing the attention of neurovascular clinicians for several reasons. First, an aging population facilitates the development of the most common forms of hemorrhagic stroke, primary ICH (due to hypertension and cerebral amyloid angiopathy), and subarachnoid hemorrhage (due to the development of intracranial aneurysms, with its chief risk factors of hypertension and tobacco use). Second, advancing neuroimaging is better at detecting not only acute hemorrhagic stroke but also at identifying subclinical hemorrhage, such as the gradient-echo magnetic resonance imaging (MRI) detection of microhemorrhage and cavernous malformations, and computed tomography (CT) and MR angiography’s definition of unruptured intracranial aneurysms and vascular malformations. There is still a role for old-school conventional cerebral angiography in the management of many patients with hemorrhagic stroke.
An era of increased awareness of hemorrhagic stroke may soon translate into a wider proliferation of treatments. The success of recombinant factor VIIa in preventing the expansion of ICH was an important first step from a large international clinical trial evaluating an emergent drug therapy. Efforts to reduce the delayed impact of toxic by products of free blood upon brain parenchyma may conceivably hold clinical benefit at much wider time windows than have proven helpful for therapies of acute ischemic stroke.
In addition, although earlier efforts of neurosurgical evacuation of hemorrhage within the brain have been unsuccessful, ongoing studies are looking at less invasive means; e.g. endoscopic aspiration and thrombolytic agents delivered via external ventricular devices, in order to reduce clot burden; or are focusing upon subgroups of patients; e.g. those patients with lobar lesions. For complex neurovascular disorders, large comparative trials have either been completed (i.e. in intracranial aneurysms, comparing neurosurgical clipping versus endovascular coiling) or are under way (i.e. in unruptured vascular malformations, comparing conservative medical therapy versus aggressive interventions).
Finally, hemorrhagic stroke is bringing together neurovascular clinicians with distinct training backgrounds. Its inhospital management gathers together vascular neurology, interventional neuroradiology, vascular neurosurgery, and neurocritical care medicine. For example, during the past 15–20 years, endovascular approaches have been developed to complement open neurosurgery in the management of intracranial aneurysms. In addition, radiation treatment is a viable option for some arteriovenous malformations.
Continuing from where previous volume left off (Ischemic Stroke: An Atlas of Investigation and Treatment), the author again intend to introduce clinicians, residents in training, and medical and nursing students to the breadth of the ‘dark side’ – hemorrhagic stroke – of neurovascular disorders. In addition to this survey of neuroimaging and neuropathology, case studies demonstrate the clinical management considerations surrounding various types of hemorrhagic stroke. The result is a broader range of clinical pathology than found in our earlier volume. This volume conclude with a survey of ‘Extreme’ Neurovascular Disorders, as a means to convey the wide array of interesting and challenging disorders encounter as clinicians.
You will find this volume on hemorrhagic stroke a useful companion to Ischemic Stroke: An Atlas of Investigation and Treatment.

Chapter 1 Intracerebral Hemorrhage

  • Epidemiology
  • Clinical presentation
  • Outcomes
  • Risk factors
  • Pathogenesis
  • Lesion locations
  • Other common causes of hemorrhage
  • Diagnosis
  • Management
  • Case studies
Case study 1. Autopsy, subcortical hemorrhage
Case study 2. Parenchymal hemorrhage associated with anticoagulation
Case study 3. Deep venous sinus thrombosis
Case study 4. Atypical lobar hemorrhage
Case study 5. Lobar hemorrhage treated with neurosurgery

Chapter 2 Intracranial Aneurysms and Subarachnoid Hemorrhage
  • Epidemiology
  • Risk factors
  • Clinical presentation
  • Diagnosis
  • Management
  • Prognosis and outcomes
  • Other related lesions
  • Case studies
Case study 1. Vasospasm causing delayed ischemia
Case study 2. Coiling an unruptured A-Comm aneurysm
Case study 3. Treatment of a mycotic aneurysm
Case study 4. Aneurysm-to-artery thromboembolic stroke

Chapter 3 Arteriovenous Malformations
  • Introduction
  • Definition, angioarchitecture, and pathology
  • Natural history
  • Clinical presentation
  • Diagnosis
  • Management
  • Outcomes
  • Case studies
Case study 1. Lobar AVM, presenting with ruptured intracranial aneurysm
Case study 2. Lobar hemorrhage due to AVM
Case study 3. Occipital AVM presenting with visual seizures
Case study 4. Micro-AVF, with PCA and MCA supply

Chapter 4 Other Vascular Malformations
  • Introduction
  • Cavernous malformations
  • Developmental venous anomalies
  • Atypical developmental venous anomalies
  • Capillary telangiectasias
  • Case studies
Case study 1. Temporal lobe cavernoma, resected
Case study 2. Resection of cerebellar cavernoma, sparing associated DVA
Case study 3. Persistent falcine sinus, with straight sinus aplasia

5 ‘Extreme’ Neurovascular Disorders
  • Introduction
  • Dural AV shunts
  • The reversible posterior leukoencephalopathy syndrome
  • Subdural hematoma
  • Intravascular lymphomatosis
  • Phakomatoses
  • CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
  • Calcifications and other hyperdensities
  • Intracranial dolichoectasia
  • Radiation arteriopathy
  • Sickle cell disease
  • Spinal cord infarction and vascular malformations

Book Details

  • Hardcover: 140 pages
  • Publisher: Clinical Publishing Services; 1 edition (June 2010)
  • Language: English
  • ISBN-10: 1846920396 
  • ISBN-13: 978-1846920394
  • Product Dimensions: 11.4 x 8.9 x 0.5 inches
List Price: $99.95

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