Stroke
|
Fall 2000
Volume 11, Number 2
|
|
Click on
any title below to read the full article.
|
|
Contents of this Issue
 From the Guest Editor
Don B. Smith, MD, Medical Director of the CNI Stroke Program
Stroke in Young Adults
Marc Marcoux, MD
Stroke in young adults is surprisingly common. The differential
diagnosis for potential etiologies is broader than that for older adults.
Elements of the initial workup, including neuroimaging, bloodwork, and
other ancillary studies, are reviewed. Emphasis is placed on areas in
which the diagnostic approach to stroke in young adults differs from that
for older patients. Clinical manifestations and management are usually
similar to, but prognosis is often better than, those in an older
population.
The Role of Hypercoagulable
States in Stroke
David R. Trevarthen, MD
Stroke is a leading cause of death and morbidity throughout the world.
The role of hypercoagulable states in the development of stroke is
controversial from reports in the literature. However, there does appear
to be an association between stroke, especially in young patients, and a
number of hypercoagulable conditions such as antiphospholipid antibody
syndrome, Leiden Factor V mutation, activated protein C resistance,
prothrombin gene G20210A mutation, protein C and protein S deficiencies.
There also does appear to be an association between some of these
conditions and cerebral vein thrombosis. Laboratory evaluation and
clinical management of these patients is discussed.
Imaging of Cerebral Ischemia and
Infarction
Peter E. Ricci, MD
MR diffusion and perfusion imaging techniques, by virtue of their
ability to identify and characterize acutely ischemic tissue, have the
potential to significantly improve clinical decision making in and care of
stroke patients. At the Colorado Neurological Institute, MR diffusion and
perfusion imaging techniques have been integrated into the routine stroke
imaging protocols. Although CT remains the initial imaging study in all
patients that present with an acute neurologic deficit, it is used
primarily to exclude the presence of hemorrhage and other stroke
mimickers. Diffusion-weighted MR imaging is now performed in all patients
in whom ischemic stroke is a diagnostic consideration.
The Role of Alternative Medicine in
Rehabilitation and Prevention of Stroke
Elena Draznin, MD
Several alternative therapy modalities can be used in rehabilitation and
prevention of stroke. Herbal medicine, nutritional supplements, acupuncture, as
well as body and mind techniques may be useful adjuncts to conventional therapy.
Clinical efficacy of these complementary approaches must be further evaluated in
prospective, randomized, and properly controlled studies. If convincing evidence
emerges in favor of the effectiveness of alternative therapies in
rehabilitation, these therapies will undoubtedly be incorporated into standard
rehabilitation protocols.
Trends in Carotid Endarterectomy
Craig Rabb, MD
Carotid Endarterectomy has been established as the treatment of choice for
the prevention of stroke related to narrowing of the carotid arteries. This
article discusses recent trends in the treatment of carotid artery stenosis,
including preoperative imaging, simultaneous carotid-coronary revacularization,
and carotid artery stenting.
Neuronal Transplantation for Stroke
Lawrence R.Wechsler, MD
Advances in treatment of stroke survivors with residual neurological deficits
has lagged behind therapy for acute stroke and stroke prevention. Neural
transplantation is an exciting new field of research for stroke patients. At the
University of Pittsburgh we treated 12 patients with basal ganglia stroke and
fixed motor deficits with a neuronal cell that have been shown in vivo to
integrate, form synapses and processes and improve neurological function in
animal models of stroke. There were no complications related to the implanted
cells either at the time of surgery or in 12 to 22 months of follow up. Eight of
the 12 patients had subjective improvements and 7 improved in European Stroke
Scale scores at 12 months. PET scans at 12 months showed at least a 15% increase
in local metabolism compared to baseline scans in 6 of 11 patients. These
results are promising and further studies in patients with stroke are planned.
|
