Stroke E-Book: Pathophysiology, Diagnosis, and Management

Description

Authored by the world’s foremost stroke experts, this classic text brings you fully up to date with current research findings and management approaches for cerebrovascular disease. Stroke: Pathophysiology, Diagnosis, and Management, 7th Edition, covers every aspect of this fast-moving field, and is an ideal resource for stroke specialists, general neurologists, and other medical professionals with an interest in stroke. You’ll find expert clinical guidance, comprehensive pathophysiology coverage, data from recent trials, advances in diagnostic tests, full-color CT images, pathology slides, and much more, for a complete picture of today’s stroke medicine.Helps you recognize the clinical manifestations of stroke, use the latest laboratory and imaging studies to arrive at a diagnosis, and generate an effective medical and surgical treatment plan. Keeps you abreast of the overwhelming volume of studies and guidelines in this dynamic field, providing clear summaries and practical evaluations of all relevant data. Contains updates throughout, including the latest clinical trials (thrombectomy, DAWN, DEFUSE), genetics research, prevention research, new therapies, and the new guidelines from the ASA. Includes new slides for lectures, covering basic science, case studies, and interventional treatment overviews. Features a Key Points summary at the beginning of each chapter so you can quickly find important information. Provides abundant full-color CT images and pathology slides that help you make efficient and accurate diagnoses. Cover Stroke: Pathophysiology, Diagnosis, and Management Copyright Contents Video Contents Foreword to the Seventh Edition Preface Contributors AHA Evidence-Based Classifications SECTION I Pathophysiology 1 - Cerebral Vascular Biology in Health and Disease Introduction Organization of the Cerebral Circulation Physiologic Regulation of Cerebral Vascular Tone Nitric Oxide and Cyclic Guanosine Monophosphate K+ Channels KCa-Activated K+ Channels KATP Channels KV Channels KIR Channels K2P Channels RhoA/Rho-Kinase Reactive Oxygen Species Transient Receptor Potential Channels Alterations in Cerebral Vascular Function During Hypertension and Atherosclerosis Atherosclerosis Cerebral Vascular Oxidative Stress in Models of Atherosclerosis Cerebral Vascular Endothelial Dysfunction in Models of Atherosclerosis Cerebral Vascular Inflammation in Models of Atherosclerosis Hypertension Oxidative Stress in Hypertension Involving Elevated Ang II Endothelial Dysfunction in Hypertension Involving Elevated Ang II Cerebrovascular Inflammation in Hypertension Involving Elevated Ang II K+ Channel Function in Chronic Hypertension BKCa Channels. Basal activity of BKCa channels may be greater in cerebral arteries during chronic hypertension, in that pharmaco... KATP Channels. To our knowledge, there is little information regarding KATP channel function in hypertension. Vasodilator respon... KV Channels. Experimental hypertension may be associated with cerebral artery depolarization and increased myogenic response, pe... KIR Channels. The first evidence for impaired KIR channel function during chronic hypertension was the finding that Ba2+-sensiti... Rho-Kinase in Hypertension Conclusion 2 - Mechanisms of Thrombosis and Thrombolysis Thrombus Formation Fibrinolysis Plasminogen Plasminogen Activation Thrombus Dissolution Plasminogen Activators Endogenous Plasminogen Activators Tissue Plasminogen Activator Urokinase-Type Plasminogen Activator Recent Considerations of Endogenous Thrombolysis That Suggest Approaches to Thrombotic Stroke Exogenous Plasminogen Activators Streptokinase Staphylokinase Plasminogen Activators Derived From Desmodus rotundus Novel Plasminogen Activators Sequential Combinations of Plasminogen Activators in Exogenous Thrombolysis Regulation of Endogenous Fibrinolysis α2-Antiplasmin and α2-Macroglobulin Inhibitors of Plasminogen Activators and Fibrinolysis Clinical Consequences of Therapeutic Plasminogen Activation Limitations to The Clinical use of Fibrinolytic Agents for Ischemic Stroke Plasminogen Activators in Cerebral Tissue Plasminogen Activators and Neuronal Functions Plasminogen Activators and Cerebral Microvessel Integrity Plasminogen Activators in Experimental Cerebral Ischemia Plasminogen Activators and Recanalization in Ischemic Stroke Intervention With Plasminogen Activators Endovascular Interventions Plasminogen Activators and Cerebral Hemorrhage in Ischemic Stroke Conclusion 3 - Cerebral Blood Flow and Metabolism: Regulation and Pathophysiology in Cerebrovascular Disease Normal Cerebral Energy Metabolism Energy Metabolism and Hemodynamics Introduction Cerebral Blood Flow and Other Measurements of Cerebral Perfusion Normal Values of Cerebral Blood Flow and Cerebral Metabolism Control of Cerebral Blood Flow Relationship of Cerebral Blood Flow and Metabolism Response of Cerebral Blood Flow to Changes in Arterial Partial Pressure of Oxygen and Oxygen Content Response of Cerebral Blood Flow to Changes in Blood Glucose Response of Cerebral Blood Flow to Changes in Arterial pCO2 Response of Cerebral Blood Flow to Changes in Blood Viscosity Autoregulation of Cerebral Blood Flow to Changes in Cerebral Perfusion Pressure Response of Cerebral Blood Flow to Multiple Simultaneous Stimuli Hemodynamic Effects of Arterial Stenosis Compensatory Responses to Reduced Cerebral Blood Flow Acute Ischemic Stroke Changes in Cerebral Blood Flow and Metabolism With Acute Ischemic Stroke Flow-Metabolism Thresholds of Tissue Function and Viability in Acute Ischemic Stroke Vasoreactivity and Autoregulation in Ischemic Stroke Remote Flow and Metabolic Effects of Ischemic Stroke Intracerebral Hemorrhage Cerebral Blood Flow and Metabolism Autoregulation Aneurysmal Subarachnoid Hemorrhage Cerebral Blood Flow and Metabolism Autoregulation Conclusions 4 - Histopathology of Brain Tissue Response to Stroke and Injury Four Broad Categories of Cerebral Ischemia Large Vessel Strokes Heart Disease and Cerebral Emboli Carotid Artery Atherosclerosis Infarction Versus Selective Neuronal Necrosis Small Vessel Strokes Hypertensive Arteriolosclerosis White Matter Incomplete Infarction Amyloid Angiopathy Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy Tissue Response to Therapy of Cerebral Ischemia Histopathology of Experimental Stroke Models Histopathology of the Penumbra in Rodent Focal Ischemia Histopathology of CA1 Neuronal Death in Transient Global Ischemia Conclusions 5 - Molecular and Cellular Mechanisms of Ischemia-Induced Neuronal Death Introduction Global Ischemia Focal Ischemia Experimental Models of Global and Focal Ischemia Models of Global Ischemia Models of Focal Ischemia Modalities of Ischemic Cell Death Necrosis Necroptosis Apoptosis Caspase-Dependent Apoptosis Alternative Pathways of Caspase Activation The Bcl-2 Family of Proteins Inhibitors of Apoptosis Caspase-Independent Apoptosis Autophagic Cell Death Ferroptosis Cell Death Patterns and Pathways in Ischemic Stroke Triggers of Ischemic Cell Death Adenosine Triphosphate Deficiency Calcium Glutamate Excitotoxicity N-methyl-d-aspartate Receptors. NMDARs are glutamate-gated ion channels, playing pivotal roles in the regulation of synaptic act... Ca2+-Permeable α-Amino-3-Hydroxy-5-Methyl-4-Isoxazole-Propionic Acid Receptors. AMPARs mediate fast synaptic transmission at exc... Nonexcitotoxic Mechanisms Acid-Sensing Ion Channels. ASICs are abundantly expressed in the neurons throughout the brain, including those in the cerebral c... Transient Receptor Potential Channels. The TRP channel superfamily is a group of weakly voltage-sensitive, largely nonselective ... Zinc Mechanisms and Regulations of Ischemic Neuronal Death Metabolic Stress Mitochondrial Permeabilization Free Radicals and Lipid Peroxidation Nitric Oxide Transcriptional Regulations p53 FOXO-3A REST NF-κB Acknowledgments 6 - Intracellular Signaling: Mediators and Protective Responses Preconditioning Windows of Preconditioning Induction of Preconditioning Cross-Tolerance Cellular Defense Reactive Oxygen Species Mitochondria Neurotrophin Support Survival Kinases Transcription Factors Erythropoietin Inhibition of Cell Death Cellular Maintenance Regeneration and Repair Use of Transcriptomics Human Cell Systems Clinical Implications Future Directions 7 - The Neurovascular Unit and Responses to Ischemia Introduction Architecture of the Central Nervous System and the Neurovascular Unit Structural Relationships: Anatomy of the Cerebral Vasculature Functional Relationships Neuron—Microvessel Communication Neuron—Astrocyte Communication. Neurovascular coupling supports the communication of neurons with astrocytes. However, interacti... Astrocyte—Endothelial Cell (Vascular) Communication. Changes in CBF can be initiated by central neural activation. Specific path... Astrocyte—Smooth Muscle Communication. Pre-capillary arterioles are instrumental in regional CBF regulation, receiving input fro... Microvessel—Neuron Communication Astrocyte—Neuron Communication. In normoxia, astrocytes play dual roles in communication between neurons and the vasculature: en... Endothelial Cell—Astrocyte Communication. Astrocyte end-feet envelope cerebral capillaries and larger microvessels, thus implyin... Evidence for the Neurovascular Unit Interactions Suggesting Unit Communication Structural Changes During Focal Ischemia Microvessel (Endothelial—Astrocyte) Communication Innate Inflammation Glymphatic Clearance Network Propagating Depolarizations and Neurovascular Unit Dysfunction Summary and Implications 8 - Mechanisms of Damage After Cerebral Hemorrhage Experimental Models of Intracerebral Hemorrhage Mechanism of Brain Injury After Intracerebral Hemorrhage Inflammatory Responses After Intracerebral Hemorrhage Oxidative Stress After Intracerebral Hemorrhage Blood Components and Intracerebral Hemorrhage-Induced Injury Red Blood Cell Lysis and Neuronal Toxicity Brain Iron Overload Thrombin Formation Mechanisms of Cell Death After Intracerebral Hemorrhage Apoptosis Excitotoxicity and Cell Death After Intracerebral Hemorrhage Additional Forms of Death After Intracerebral Hemorrhage Blood-Brain Barrier Disruption Modifiers of Intracerebral ­Hemorrhage-Induced Injury Hypertension Sex Age Therapeutic Approaches Targeting ICH Pathogenesis in Animal Research Surgical Treatment for Intracerebral Hemorrhage Pharmacologic and Other Experimental Treatment for Intracerebral Hemorrhage Conclusion 9 - White Matter Pathophysiology White Matter Anatomy and Physiology Model Systems for Studying White Matter Ischemia Cell Culture In Vitro Tissue Models In Vivo Models Effects of Ischemia on White Matter Derangement of Transmembrane Ion Gradients The Ca2+ Hypothesis and Anoxic-Ischemic White Matter Injury Mechanisms of White Matter Injury Ca2+ Entry and Intracellular Ca2+ Release in Axons During Ischemia Reversal of Na+–Ca2+ Exchange Activation of Voltage-Gated Ca2+ Channels Activation of Intracellular Ca2+ Release Excitotoxic Pathways Injure Glia in White Matter Autoprotection in White Matter Strategies for Protecting White Matter from Anoxic-Ischemic Injury Are Diverse 10 - Inflammation and Immune Response Initiation and Local Propagation of the Immune Response After Stroke Intravascular Events Leading to Inflammation Parenchymal Events Leading to Inflammation Cellular Injury and Damage-Associated Molecular Patterns Release Microglia Response Role of Other Brain Resident Immune Cells, Astrocytes, and Neurons in Inflammation After Stroke The Peripheral Immune Response to Stroke Timeline of the Peripheral Immune Response Gaining Access to the Brain—Entry Points of Peripheral Immune Cells Innate Immune Cells Adaptive Immune Cells Noncoding RNAs and Exosomes as Modulators of the Immune Response The Role of the Immune System in Post-Stroke Brain Repair Phagocytosis Contributing to the Resolution of the Inflammatory Response Mechanisms of Neurovascular Repair: Angiogenesis, Neurogenesis, and Neuroplasticity Immunomodulation and Immune Cell Therapies as a Therapeutic Approach Immune Cell Therapies Targeting Neuroprotection Immunomodulatory Therapeutic Approaches Targeting Tissue Remodeling From Bench to Bedside Conclusions Acknowledgments 11 - Mechanisms of Plasticity Remodeling and Recovery Introduction Endogenous Brain Remodeling After Stroke Angiogenesis Neurogenesis Axonal Remodeling, Oligodendrogenesis, and Synaptogenesis Inflammatory Response Exogenous Therapies for Stroke Cell-Based Therapies Cell Reprogramming for Neurogenesis Bone Marrow MSCs Therapeutic Effects. Bone marrow MSCs are the most-studied adult stem cells and have been widely utilized in th... Exosome Therapies HUCBC-Exosome Therapy MSC-Exosome Therapy Modified-Exosome Therapy Pharmacologic Therapies Conclusion 12 - Genetics and Vascular Biology of Brain Vascular Malformations Brain Arteriovenous Malformations Etiology and Pathogenesis Somatic Mosaicism in Sporadic Arteriovenous Malformations Arteriovenous Malformation Pathobiology Genetic Considerations Relevant to Arteriovenous Malformations Mendelian Disease Familial Aggregation Genetic Studies of Non-familial Arteriovenous Malformation Candidate Gene and Genome-Wide Studies Insights From Experimental Arteriovenous Malformation Models Summary and Synthesis of Arteriovenous Malformation Etiology and Pathogenesis Cerebral Cavernous Malformations Overview Cerebral Cavernous Malformation Genetics CCM1/KRIT1 CCM2/MGC4607 CCM3/PDCD10 Cerebral Cavernous Malformation Pathogenesis and Biology Genotype-Phenotype Correlation Summary of Cerebral Cavernous Malformation Biology and Pathogenesis Other Vascular Malformations Summary of Other Vascular Malformations Acknowledgments 13 - Gliovascular Mechanisms and White Matter Injury in Vascular Cognitive Impairment and Dementia Introduction The Neurovascular Unit in Vascular Cognitive Impairment and Dementia Experimental Models for Vascular Cognitive Impairment and Dementia Spontaneously Hypertensive Stroke Prone Rat Rat Bilateral Common Carotid Artery Occlusion Mouse Bilateral Common Carotid Artery Stenosis Rat and Mouse Two-Vessel Gradual Occlusion Focal Injection of Vasoconstrictors Transgenic CADASIL Mice Middle Cerebral Artery Occlusion Astrocyte and Extracellular Matrix Dysfunction Oligodendrocyte Lineage Cells Oligodendrocyte-Endothelium Interactions Oligodendrocyte-Astrocyte Interactions Oligodendrocyte-Microglia Interactions The Gliome and the Vasculome Conclusions and Future Opportunities SECTION II Epidemiology and Risk Factors 14 - Global Burden of Stroke Introduction GBD Methods Overall Stroke Estimates Ischemic Stroke Hemorrhagic Stroke Sex Differences Interpretations of GBD Stroke Trends 15 - Stroke Disparities Introduction Racial and Ethnic Disparities in Stroke Sex Disparities in Stroke Geographic Disparities in Stroke Urban-Rural Disparities in Stroke Regional Differences in Stroke Socioeconomic Status and Stroke Conclusions 16 - Risk Factors and Prevention Epidemiology and Risk Factors Magnitude of the Problem Mortality Cost Incidence of Stroke Frequency of Stroke by Type Silent Stroke Recurrent Stroke Vascular Bruits Risk Factors for Stroke Atherogenic Risk Factors Hypertension Hypertension and the Risk of Stroke. About 77% of people who have a first stroke, about 69% who have a first heart attack, and a... Isolated Systolic Hypertension. Isolated systolic hypertension (≥160/