SECTION 1: DIAGNOSIS, EVALUATION, AND
TREATMENT OF STROKE
1. Overview of Stroke
Classification
Detection and Evaluation of Stroke
History, Physical Exam, and Laboratory Testing
Imaging
• CT/MRI
• Doppler Ultrasound
• Magnetic Resonance and Computed
• Tomography Angiography
• Cerebral Angiography
• Lumbar Puncture
• Echocardiogram
• Electrocardiography
• Holter Monitoring
• Electroencephalography
2. Ischemic Stroke
Clinical Features
Overview of Treatment
Presentation
Lytic-eligible Patients
Lytic-ineligible Patients
• Antiplatelet Therapy
• Heparin Therapy
o Clinical Trials
o Recommendations
o Heparin Dose
Measures to Prevent Recurrent Stroke
Large Artery Atherothrombosis
• Internal Carotid Artery
• Vertebral Artery
• Intracranial Disease
Brain Embolism
• Atrial Fibrillation
• Acute Myocardial Infarction
• Valvular Heart Disease
• Cardiomyopathy
• Atrial Myxoma
• Paradoxical Embolism
• Other Cardiac Conditions
Lacunar Stroke
Transient Ischemic Attack
3. Thrombolytic Therapy for Ischemic Stroke
Overview
• Baseline Evaluation
Dosing and Administration
Post-lytic Care
• General Measures
Inclusion and Exclusion Criteria
Management of Elevated Blood Pressure
Management of Lytic Complications
NIH Stroke Scale
4. Brain Hemorrhage
Clinical Features
• Subarachnoid Hemorrhage
Ruptured Saccular (Berry) Aneurysm
• Overview
• Treatment
Ruptured AV Malformation
• Overview
• Treatment
• Complications
• Rebleeding
• Vasospasm
• Increased Intracranial Pressure
• Hydrocephalus
Intracerebral Hematoma
• Cardiac
• Hyponatremia
Intracerebral Hemorrhage
• Hypertension
• Other causes
• Cerebellar Hemorrhage
• Subdural and Extradural Hematoma
5. Stroke-Related Complications
Treatment
• Increased Intracranial Pressure
• Seizures
• Deep Venous Thrombosis
• Pulmonary Embolism
• Depression
• Hypertension
• Myocardial Infarction
• Arrhythmias
• Infections and Sepsis
• Upper Gl Bleed
• Hyponatremia
• Respiratory Depression
• Depressed Consciousness
• Fever
• Malnutrition
• Contractures
• Decubitus Ulcers
6. Miscellaneous Topics in Cerebrovascular Disease
Asymptomatic Carotid Artery Stenosis
• Stenosis >60%
• Stenosis <60%
Unruptured Aneurysm
Carotid Endarterectomy
Extracranial-intracranial Bypass
Carotid and Vertebral Artery Stenting
7. Stroke Pitfalls
8. Controversies in Stroke Management
Stroke and Patent Foramen Ovale
Antiplatelet Agents or Anticoagulation
• with Warfarin
• PFO Closure
Large Hemispheric Stroke within 3–6 Hours
• IV tPA
• IA tPA
• MERCI Retriever
Hemicraniectomy for Malignant MCAStroke
Craniotomy/Evacuation for Supratentorial ICH
• Benefi ts of Surgery
• Contraindications of Surgery
Antiplatelet Agents for Secondary Stroke Prevention
• Aspirin
• Clopidogrel or Aspirin and Extended Release Dipyridamole
Timing of Carotid Surgery After Recent Stroke
• Early vs Late
Acute Mild Stroke
SECTION 2: CEREBROVASCULAR & CARDIOVASCULAR RISK REDUCTION
9. Overview of Risk Reduction
• Annual Risk Percentage
• Modifiable Risk Factors
10. Therapeutic Lifestyle Changes
Diet Modification
• Therapeutic Lifestyle Changes Diet
• Recommendations
• Dietary Options for Risk Reduction
Mediterranean-Style Diet
• Mediterranean Diets
• Other Studies
• Recommendations
• Basic Components
• How to Incorporate
Physical Activity
• Overview
• Amount and Type of Exercise
• Stress Testing
Weight Control
• Overview
• Classifi cation of Obesity
• Evaluation of Obesity
• Treatment of Obesity
• Antiobesity Drugs Approved by the FDA
Smoking Cessation
• Overview
• Guidelines
• Strategies to Assist Patients to Quit
• Drug Therapy
11. Antiplatelet and AntithromboticTherapy to Prevent Recurrent Ischemic Stroke
Antiplatelet Therapy
Atherothrombosis as a Systemic Disease
Role of the Platelet
Antiplatelet Monotherapy
• Aspirin
• Clopidogrel
• Ticlopidine
Combination Antiplatelet Therapy
• Aspirin Plus Dipyridamole
• Aspirin Plus Clopidogrel
Summary
Antithrombotic Therapy
12. Control of Hypertension
Diagnosis and Evaluation
Proper Blood Pressure Measurement
Excluding Conditions Leading to Overdiagnosis
• White-coat Hypertension
• Pseudohypertension
Assessing Target Organ Damage
Secondary Hypertension
Treatment of Hypertension
Blood Pressure Goals
Drug Therapy
• Initial Therapy
• Intensifi cation of Therapy
• Combination Therapy
• Stepdown Therapy
Optimizing Patient Compliance
13. Control of Dyslipidemia
Diagnosis Evaluation and Treatment
• Lipoprotein Analysis
• Secondary Causes
• Genetic Dyslipidemia
• LDL/Non-HDL Cholesterol Goals
• Metabolic Syndrome
Treating Elevated LDL Cholesterol
Treating Low HDL Cholesterol
Treating Elevated Triglyceride
Drug Therapy for Dyslipidemia
14. Other Measures to Prevent Atherothrombosis and Stroke
Control of Diabetes Mellitus
ACE Inhibitors
Low-dose Fish Oil
Arterial Revascularization
• Carotid Endarterectomy
• Carotid Angioplasty and Stenting
Folic Acid
Antioxidants
Hormone Replacement Therapy
Citicoline
SECTION 3: CLINICAL TRIALS
Stroke Prophylaxis in Atrial Fibrillation (AF)
Antiplatelet/Antithrombotic Therapy for TIAs or Minor Strokes
Antiplatelet/Antithrombotic Therapy and Heparin for Acute Stroke
Randomized Thrombolysis Trials
Carotid Endarterectomy Trials
Cerebral Angioplasty/Stent Trials
Miscellaneous Stroke Trials
Hypertension Trials
Dyslipidemia and Other Risk Reduction Trials
Neuroprotection Trials
Intracerebral Hemorrhage Trials
SECTION 4: Film Library
References and Suggested Readings
Index
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