Download e-book for kindle: Cerebrovascular Disease by Ji Y. Chong
By Ji Y. Chong
Sufferers struggling with cerebrovascular affliction pose many medical demanding situations or even skilled clinicians can arrive on the aspect the place diagnostic, work-up, remedy, or prognostic considering falters.
Authored by way of a vascular neurologist whose paintings spans the complete spectrum of this workforce of mind dysfunctions, Cerebrovascular Disease is helping clinicians assessment and deal with sufferers struggling with stroke, embolism, thrombosis, hemorrhage, and different severe displays. In a clinical box the place it is frequently tricky to distill the huge array of study and follow it in any significant scientific approach, this subsequent quantity within the "What Do I Do Now?" sequence specializes in jogging the clinician via evidence-based decision-making. each one medical situation featured in Cerebrovascular Disease describes in cautious aspect the presentation, diagnostic reports, cures, and purpose for dealing with those tough instances.
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Asymptomatic hemorrhage can occur even without tPA. Hemorrhage within already infarcted tissue may not cause any symptoms. Hemorrhagic transformation is more commonly seen in strokes due to cardiac embolus. 1 Non-contrast head CT prior to IV tPA showing no hemorrhage but a basal ganglia calciﬁcation. 2 Non-contrast head CT 24 hours post-tPA showing left MCA and ACA territory infarct with hemorrhagic transformation. 22 WHAT DO I DO NOW? CEREBROVASCULAR DISEASE It is important to distinguish asymptomatic hemorrhagic transformation from symptomatic hemorrhage.
Stroke. 2012;43:2293–2299. 24 WHAT DO I DO NOW? CEREBROVASCULAR DISEASE 5 Stroke Mimic and Acute Treatment A 41-year-old woman with hypertension and migraines presented with acute left arm weakness and numbness and headache. She had migraines for ﬁve years with holocephalic headaches but no aura. Three years prior to presentation, she was hospitalized at another hospital for left-sided sensory loss and dysarthria in the setting of a migraine. She was told she had had a stroke. She returned to normal after that event.
1 CT scan showing infarction of the complete RMCA territory with edema causing compression of the right lateral ventricle and shift of midline structures to the left. T his is a patient with a malignant RMCA stroke. He has clinical signs of the full MCA territory being infarcted, and his imaging is consistent with this. It is important to recognize malignant MCA syndromes, since there is a very high association with early worsening and death (up to 80%). Predictors of a malignant pattern include high initial NIHSS, usually over 16; younger age (less atrophy and room for swelling); and early signs of edema.
Cerebrovascular Disease by Ji Y. Chong