Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- SECTION I NEUROLOGICAL EXAMINATION AND NEURODIAGNOSTIC TESTING
- SECTION II COMMON NEUROLOGICAL PRESENTATIONS
- SECTION III SPECIFIC NEUROLOGICAL CONDITIONS
- 11 Central Nervous System Infections in Adults
- 12 Cerebrovascular Disease
- 13 Movement Disorders
- 14 Peripheral Nervous System and Neuromuscular Disorders
- 15 Guillain-Barré Syndrome
- 16 Myasthenia Gravis
- 17 Musculoskeletal and Neurogenic Pain
- 18 Neuro-Ophthalmological Emergencies
- 19 Multiple Sclerosis
- 20 Dementia
- 21 Brain Tumors and Other Neuro-Oncological Emergencies
- 22 Neuropsychiatry
- 23 Increased Intracranial Pressure and Herniation Syndromes
- 24 Idiopathic Intracranial Hypertension
- 25 Normal Pressure Hydrocephalus
- 26 Nontraumatic Spinal Cord Emergencies
- 27 Sleep Disorders
- SECTION IV NEUROLOGICAL TRAUMA
- SECTION V PEDIATRIC NEUROLOGICAL EMERGENCIES
- SECTION VI PREGNANCY-RELATED NEUROLOGICAL EMERGENCIES
- SECTION VII NEUROTOXICOLOGY
- SECTION VIII BRAIN DEATH
- Index
- References
12 - Cerebrovascular Disease
from SECTION III - SPECIFIC NEUROLOGICAL CONDITIONS
Published online by Cambridge University Press: 06 August 2009
Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- SECTION I NEUROLOGICAL EXAMINATION AND NEURODIAGNOSTIC TESTING
- SECTION II COMMON NEUROLOGICAL PRESENTATIONS
- SECTION III SPECIFIC NEUROLOGICAL CONDITIONS
- 11 Central Nervous System Infections in Adults
- 12 Cerebrovascular Disease
- 13 Movement Disorders
- 14 Peripheral Nervous System and Neuromuscular Disorders
- 15 Guillain-Barré Syndrome
- 16 Myasthenia Gravis
- 17 Musculoskeletal and Neurogenic Pain
- 18 Neuro-Ophthalmological Emergencies
- 19 Multiple Sclerosis
- 20 Dementia
- 21 Brain Tumors and Other Neuro-Oncological Emergencies
- 22 Neuropsychiatry
- 23 Increased Intracranial Pressure and Herniation Syndromes
- 24 Idiopathic Intracranial Hypertension
- 25 Normal Pressure Hydrocephalus
- 26 Nontraumatic Spinal Cord Emergencies
- 27 Sleep Disorders
- SECTION IV NEUROLOGICAL TRAUMA
- SECTION V PEDIATRIC NEUROLOGICAL EMERGENCIES
- SECTION VI PREGNANCY-RELATED NEUROLOGICAL EMERGENCIES
- SECTION VII NEUROTOXICOLOGY
- SECTION VIII BRAIN DEATH
- Index
- References
Summary
Cerebrovascular disease encountered in the emergency department (ED) includes transient ischemic attacks (TIAs) and infarcts (strokes). The purpose of the initial evaluation is to determine whether there is evidence of a stroke, what part of the brain is affected, and whether the patient is a candidate for urgent intervention such as thrombolytic therapy. A chemistry profile, complete blood count (CBC) with platelets, and coagulation profile are essential after completion of brief examination. Attention to adequate airway protection, oxygenation, and circulatory function is essential for management of patients with acute stroke. The use of anticoagulants (heparin or low molecular heparins) remains the most controversial subject in the management of acute stroke. Patients with acute or hemorrhagic strokes need to be admitted to the hospital for further evaluation and management. A neurosurgeon should participate in the care of most patients with intracerebral hemorrhages (ICH) and all patients with subarachnoid hemorrhages (SAH).
Keywords
- Type
- Chapter
- Information
- Principles and Practice of Emergency NeurologyHandbook for Emergency Physicians, pp. 131 - 145Publisher: Cambridge University PressPrint publication year: 2003
References
A special Writing Group of the Stroke Council, American Heart Association Guidelines for Thrombolytic Therapy for acute stroke. A supplement to the guidelines for the management of patients with acute ischemic stroke. 1996; 94: 1167–74
, , , , . Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Altepase to Reverse Stroke (STARS) study. JAMA. 2000; 283: 1145–50Google Scholar
, , , et al. Tinzaparin in acute ischaemic stroke (TAIST): a randomized aspirin-controlled trial. Lancet. 2001; 358: 702–10Google Scholar
, , , . Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: a double-blind randomised study. HAEST Study Group Heparin in Acute Embolic Stroke Trial. Lancet. 2000; 355: 1205–10Google Scholar
, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999; 30: 905–15Google Scholar
CAST (Chinese Acute Stroke Trial) Collaboration Group. CAST: randomized placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet. 1997; 349: 1641–9
, , , et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40,000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke. 2000; 31: 1240–49Google Scholar
, , , et al. Effects of ticlopidine on the neurologic outcome and the hemorheologic pattern in the postacute phase of ischemic stroke: a pilot study. Angiology. 1990; 41: 505–11Google Scholar
, , , , , . Recombinant tissue-type plasminogen activator (Altepase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS study: a randomized controlled trial. Altepase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999; 282: 1504–9Google Scholar
Counsell C, Sandercock P. Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischemic stroke. In: The Cochrane Library, Issue 1. Oxford, UK; 2000
, , , et al. Treatment of acute ischemic stroke with the low-molecular-weight heparin certoparin. Results of the TOPAS Trial. Stroke. 2001; 32: 22–9Google Scholar
EAFT Study Group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet. 1993; 342: 1255–62
European Stroke Council, European Neurological Society and European Federation of Neurological Societies. European Stroke Initiative recommendations for stroke management. Cerebrovasc Dis. 2000; 10: 335–51
Gubitz G, Counsell C, Sandercock P, et al. Anticoagulants for acute ischemic stroke (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford, UK; 2000
Gubitz G, Sandercock P, Counsell C. Antiplatelet therapy for acute ischemic stroke. In: The Cochrane Library, Issue 1. Oxford, UK; 2000
International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomized trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet. 1997; 349: 1569–81
, , , et al. Low-molecular-weight heparin for the treatment of acute ischemic stroke. N Engl J Med. 1995; 333: 1588–93Google Scholar
, . Low-dose subcutaneous heparin in the prevention of deep-vein thrombosis and pulmonary emboli following acute stroke. Age Ageing. 1986; 15: 84–8Google Scholar
, et al. Guidelines for the management of aneurismal subarachnoid hemorrhage. A statement for healthcare professional from a special writing group of the stroke council, American Heart Association, Circulation. 1994; 90: 2592–605Google Scholar
Multicentre Acute Stroke Trial – Italy (MAST-I) Group. Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet. 1995; 346: 1509–14
Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Low molecular weight heparinoid, ORG 10172 (Dsanaparoid), and outcome after acute ischemic stroke. JAMA. 1998; 279: 1265–72
The Abciximab in Ischemic Stroke Investigators. Abciximab in acute ischemic stroke: a randomized, double-blind, placebo-controlled, dose-escalation study. Stroke. 2000; 31: 601–9
The NINDS rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995; 333:1581–7