Contents
Preface
Chapter 1
Management of Carotid Stenosis: Carotid Revascularization in the Modern Era
Abstract
Atherosclerosis: The Role of Inflammation
Evolution of Carotid Revascularization
The North American Symptomatic Carotid Endarterectomy Trial (NASCET)
Ideal Timing for Revascularization Procedures
The Asymptomatic Carotid Artery Surgery Trial (ACAS)
The Asymptomatic Carotid Surgery Trial (ACST-1)
Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Trial (SAPPHIRE)
The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST)
Carotid Revascularization in Asymptomatic Patients
Carotid Revascularization in the Elderly
Carotid Revascularization in Women
Physician Specialty and the Choice of Revascularization Procedure
Carotid CAS Complication Rates over Time
Making the Case for Intensive Medical Therapy for Asymptomatic Carotid Stenosis
Future Directions
References
Chapter 2
Ischemic Stroke: From Acute Treatment to Long-Term Recovery
Abstract
Introduction
Acute Ischemic Stroke Treatment
Future Directions and Conclusion
Stroke Prevention: Managing Modifiable Risk Factors
Treatment of Hypertension
Atrial Fibrillation
Treating Hyperlipidemia
Diabetes
Antiplatelet Therapy
Cilostazol in the Management of Atherosclerosis
Stroke Rehabilitation
Neuroplasticity and Mechanisms of Recovery
References
Chapter 3
Ischemic Stroke Prevention in Vietnam
Abstract
Introduction
Stroke Prevalence and Incidence
Morbidity and Mortality Trend
Risk Factors of Stroke
Non-Modifiable Risk Factors
Modifiable Risk Factors
Prevention Strategy in Vietnam
Conclusion
References
Chapter 4
Modulation of Protein Kinase C Isoforms: A Potential Therapeutic for Ischemic Stroke?
Abstract
Introduction
PKC Isoforms – A Lesson in Structure-Function Relationships
Expression of PKC Isoforms – Systemic and Cellular Considerations
Activation of PKC Isoforms
Regulating PKC Activation
PKC – A Role in Disease Processes?
Effect of Neural Disease and Injury on Pkc Activity
Alzheimer’s Disease (AD)
Ischemia
Ischemic Preconditioning
Traumatic Brain Injury
Role of Pkc in Neural Injury Outcome
Modulation of Response to Oxidative Stress
Effect of PKC on Cell Survival
Regulating BBB Integrity Through Matrix Remodeling
Role in Recovery and Repair Following Neural Injury
Effect of PKC Modulation on Learning and Memory
Studying Pkc Isoform-Specific Events: Using Available Tools
Future Directions
Alterations in PKC-Mediated Signaling Associated with Aging
Elucidating Cell-Specific and Time-Dependent Events
Understanding PKC-Mediated Pathways
Conclusion
References
Chapter 5
Role of Transcranial Doppler Ultrasonography in Cerebrovascular Disease
Abstract
Introduction
Fast Track Insonation Protocol
Prolonged TCD Monitoring
Therapeutic TCD
Ultrasound Contrast Agents and Sonothrombolysis
TCD in Cartoid Stenosis and Endarterectomy
TCD in Intracranial Stenosis
Vasomotor Reactivity
Right-to-Left Shunt Detection
Use of TCD in Sickle Cell Disease
TCD for Vasospasm Studies in Subarachnoid Hemorrhage (SAH)
Transcranial Color-Coded Duplex (TCCD)
Future Developments
References
Chapter 6
Inflammation in Ischemic Stroke: Mechanisms, Diagnosis and Management
Abstract
I. Introduction
II. Pathophysiology
a. Cytokines
b. Microglia
c. T Cells
III. Diagnostic Imaging
a. Computed Tomography (CT)
b. Magnetic Resonance Imaging (MRI)
c. Ultrasound
d. Single Photon Emission Computed Tomography (SPECT)
e. Near-Infrared Fluorescence (NIRF)
IV. Prevention and Treatment
a. Prevention
b. Treatment
b1. Currently Available Therapies
b2. Novel Therapies
Pharmacologically Induced Hypothermia
Erythropoietin
Other Neuroprotective Agents
Cell-Based Therapies
Summary and Conclusion
References
Chapter 7
Ischemic Stroke Susceptibility Gene Research: Lessons We Learned
Abstract
Overview of Strokes
Stratification of Ischemic Stroke
Risk Factors for Stroke
Monogenic Disorders Associated with Ischemic Stroke
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoenchephalopathy (CADASIL)
Cerebral Autosomal-Recessive Arteriopathy with Subcortical Infarcts and Leukoenchephalopathy (CARASIL)
Fabry’s Disease
Sickle-Cell Disease
Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS)
Homocystinuria
Moyamoya Disease
Marfan’s Syndrome
Ehlers-Danlos Syndrome
Periods in the Stroke Susceptibility Research
The Classic Genetic Risk Factors and the Stroke
Further Search for the Functional SNPs in Stroke
Direct Genome-Wide Association Studies in Ischemic Stroke Biobanks
Concluding Remarks
Acknowledgments
References
Chapter 8
Perioperative Ischemic Stroke
Abstract
Introduction
Epidemiology
Pathogenic Mechanism
Prognosis
Risk Factors
1) Patient Factors
Age and Co-morbiditiy
History of Stroke
Carotid Stenosis
2) Surgery Factors
Blood Pressure Control
Anesthesia
Cardiac Surgery
Perioperative Drug Use
Anti-platelet Agents or Anti-coagulants
Statins
Beta-Blockers
Risk Stratification
Treatment
Conclusion
References
Chapter 9
Traditional Medicine in the Treatment and Prevention of Ischemic Stroke
Abstract
Abbreviations Used
Introduction
Traditional Medicine – An Overview
Traditional African Medicine (TAM)
Traditional Chinese Medicine (TCM)
Stroke
Cerebral Ischemia – Pathophysiology and Mechanisms
Yin-Yang Theory in TCM
Basic Principles of Stroke in TCM
Traditional Chinese Medicine and Stroke Therapy
Herbs Used for Treatment or Prevention of Stroke in TCM
Acanthropanax Senticosus Harms
Angelica Sinensis, A. Gigas
Astragalus Membranaceus
Bombycis Corpus
Carthamus Tinctorius
Corydalis Yanhusuo
Ginkgo Biloba
Ligusticum Wallichii Franchat
Lycium Barbaarum L.
Magnolia Officinalis Rehder Et Wilson
Paeonia Suffruticosa Andrews, Paeonia Lactiflora Pall
Panax Ginseng
Pueraria Lobata
Rhodiola Rosea L., Rhodiola Sacra S. H. FU, Rhodiola Sachalinensis A. BOR
Salvia Miltiorrhiza Bunge
Schisandra Chinensis
Scutellaria Baicalensis
Sophora Japonica L.
Stephania Tetrandra S. Moore
Herbal Prescriptions in TCM
Buyang Huanwu Decoction (BYHWD) 补阳还五汤
Buchang Naoxintong Jiaonang (BNJ) 步长脑心通胶囊
Danqi Piantang Jiaonang (DJ) 丹芪偏袒胶囊
Huang Lian Jie Du Decoction (HHD) 黄连解毒汤
Kueichih Fuling Wan (KFW) 桂枝茯苓丸
Qingkailing (QKL) Injection 清开灵注射液
Qizhu Tang Decoction (QZT) 芪术汤
Shengmai San 生脉散
Acupuncture
Traditional Chinese Medicine – Weakness
Traditional Chinese Medicine – Future Developments
Conclusion
References
Chapter 10
Ischemic Stroke in Children: Symptoms, Prevention and Recovery
Abstract
Introduction
Arterial Ischemic Stroke
Clinical Presentation
Etiologies and Risk Factors
Cardiac Disease or Intervention
Cerebral Arteriopathies
Prothrombotic and Hematological Disorders
Genetic and Other Risk Factors
Risk Factors for Ischemic Perinatal Stroke
Treatment and Prevention of Childhood AIS
General Treatment of AIS
Acute Treatment
Hyperacute Thrombolytic Therapy
Acute Antithrombotic Therapy
Supportive Therapy
Long Term Therapy
Secondary Prevention
Rehabilitative Approaches
Treatment of Specific Etiological Disorders Associated with Ischemic Stroke
Recovery and Outcome
Cerebral Sinovenous Thrombosis
Clinical Presentation
Etiologies and Risk Factors
Clinical Diagnosis
Treatment
Future Directions
References
Chapter 11
The Immune System and Strokes
Abstract
Introduction
Cells of the Immune System
Role of Inflammation and the Immune System in Stroke
Immune System-Brain Interactions in the Acute Phase of a Stroke
Natural Regulatory T Cells
Targets for Stroke Prevention: Role of Inflammation and Immunity
Immunomodulation to Restrict Brain-Tissue Damage after a Stroke
Difficulties in Translation from Bench to Bedside and Research Priorities
Modulation of the Post-Ischemic Immune Response to Improve the Stroke Outcome
References
Chapter 12
Pathophysiology of Strokes
Abstract
Introduction
Mechanisms of Neuronal Injury
Concept of Ischemic Penumbra
Cerebral Edema and Its Effects
Effects of Ischemia on Structural Integrity of Brain
Hemorrhagic Stroke
Atherosclerosis and Stroke
Free Radicals in Cerebral Damage
Excitotoxicity
Cortical Spreading Depolarizations
Inflammation
Inflammation and Stroke
Infective Conditions Associated with Stroke
Inflammatory Mediators in Acute Stroke
Inflammatory Gene Expression
Cytokines
Chemokines
Matrix Metalloproteinases (MMPs)
Adhesion Molecules
Neuropeptides
Cellular Arm
Leukocytes
Microglia
Acute Phase Reactants and Body Temperature
C-reactive Protein
Erythrocyte Sedimentation Rate And Fibrinogen (ESR)
Body Temperature
Role of Neuroimaging in Evaluation of CNS Inflammation in Stroke
Proposed Interactions Unifying Various Pathophysiologic Mechanisms
Inflammatory Mechanisms
Procoagulant State
Vasculitis and Altered Circulation
Stroke Risk Factors and Triggers
Risk Factors and Propensity to Stroke?
Cerebral Blood Vessel Alteration by Risk Factors?
Role of Stroke Triggers
Parenchymal Failure: Brain death during Ischemia?
Prominent Mechanisms Leading to Cell and Tissue Demise in Stroke?
Causes of White Matter Damage Underlying Vascular Cognitive Impairment VCI?
Stroke and Dementia?
Brain Repairment after Stroke
Implications for Therapeutic Intervention beyond Thrombolytics
Currently Available Agents with Anti-Inflammatory Role
Novel Therapeutic Agents with Anti-Inflammatory Role
Predictive Role of Blood Biomarkers in Ischemic Stroke
Conclusion
References
Chapter 13
Inflammation and Anti-Inflammatory Agents in Strokes
Abstract
Introduction
Immune Activation and Systemic Inflammation Before a Stroke
Post-Ischemic Inflammation
Cytokines and Brain Inflammation
Chemokines and Brain Inflammation
Cellular Adhesion Molecules
Matrix Metalloproteinases
Proinflammatory Cytokines in Strokes
Interleukin-1?
Interleukin-6
Tumor Necrosis Factor Alpha (TNF-?)
MCP-1
Adipokines
Anti-Inflammatory Strategies
Statins
Thiazolizinediones
Other Inflammatory Drugs
Inflammation and Ischemic Tolerance
Conclusion
References
Chapter 14
Major Advances in the Treatment of Strokes
Abstract
Introduction
Mechanisms of Neuronal Injury and the Therapeutic Possibilities
Current Status of Neuroprotectant Development: Drug Development Shortcomings
Drugs Used in Acute Stroke Therapy
Plasminogen Activators
Adjuvant Drugs
Endovascular Therapy of Acute Stroke
Intra-Arterial Thrombolysis
Mechanical Thrombectomy
Intra-arterial (IA) Mechanical Therapies
Surgical Interventions
Percutaneous Transluminal Angioplasty
Endovascular Thromboaspiration
Endovascular Thrombectomy
Augmented Fibrinolysis
Thrombus Entrapment
Temporary Endovascular Bypass
Flow Augmentation
Reperfusion Therapies
Thrombolytic Agents
Promising Directions and Potential Targets in Neuroprotectant Development
Modulating Astrocyte Activity
Inhibiting Effects of Microglia
Neuroprotective Therapies
Modulating the Blood-Brain Barrier (BBB)
Targeting Inflammation
Inflammation: A Deleterious Event or a Beneficial Response?
Inflammation
Excitotoxicity and NMDA Glutamate Receptors
Mitochondrial Dysfunction
Anti-apoptotic Agents
Antioxidant Therapy
Glutamate antagonists
Ion Channel Modulators
Repair and Recovery Strategies of Stroke: Trophic Factors and Cell-Based Therapies
Macrophage Polarization as Therapeutic Tool
M1 versus M2: Classical Versus Alternative Activation
Classically Activated Macrophages (M1)
Alternatively Activated Macrophages (M2)
Neuronal Rescue
Future Directions: Therapeutic Targeting of Macrophage Subsets
Moving Forward: Charting a Course toward New Stroke Therapies
How Does the Brain Protect Itself? Lessons from Ischemic Tolerance
Therapeutic Hypothermia: Engaging Pleiotropic Mechanisms in Multiple Cell Types
Gaining Insight from the Bedside: Utility of Biomarkers
Biomarkers for Diagnosis and Prognosis
Biomarkers for Elucidating Disease Pathophysiology
Key Advances in Stroke
Current Devices Used for Mechanical Embolus Removal in Cerebral Ischemia
Penumbra Device
Stent-Assisted Recanalization in Acute Ischemic
Future Directions in Stroke Therapy:Logistics of Care
Technological Advances
Pharmacological Advances
Conclusion
References
Chapter 15
Stem Cells and Treatment of Strokes
Abstract
Introduction
Stem Cell Therapy in Stroke Patients: The Challenges
Which Stem Cells Should Be Used?
Neural Stem/Progenitor Cells
Hematopoietic Stem/Progenitor Cells
Mesenchymal Stem Cells
Bone Marrow Mononuclear Cells (BMMNCs)
Mechanism of Action of Stem Cell Therapy
Promotion of Neurogenesis and Other Endogenous Repair Processes by Stem Cell Therapy
Benefits of Stem Cell Therapy to Patients
Optimal Timing for Treatment
Delivery Route of Stem Cells
How Can Transplanted Cells Be Tracked?
Stem Cell Therapy in Stroke Patients: Clinical Trials
Chronic Stroke Trials
NT2N Cells
Mesenchymal Stem Cells
Bone Marrow Mononuclear Cells
Ongoing Chronic Trials
Acute Stroke Trials
Bone Marrow Mononuclear Cells
Ongoing Acute/Subacute Trials
The Future
Sources of Transplant Cells
Multipotent Cell Transplants in Animal Models of Stroke
Cell Transplants in Human Stroke
Possible Mechanisms
Conclusion
References
Chapter 16
An Introduction to Cerebrovascular Diseases
Abstract
Introduction to Cerebrovascular Diseases
Anatomy of the Cerebrovascular Disease
Anterior Circulation
Posterior Circulation
Circle of Willis
Pathophysiology of Cerebrovascular Diseases
Cardiac Conditions Associated with Embolization
Sub-Types of Stroke and their Categorization
Atherosclerosis and Stroke
1. Injury to Arterial Wall
2. Role of Monocytes and T-Lymphocytes in Foam Cell Transformation
3. Oxidation of LDL-Cholesterol
4. Smooth Muscle Cell Migration and Proliferation
5. Role of Platelet
6. Plaque Fissuring and Thrombus Formation
7. The Potential Outcomes of Plaque Fissuring
8. Evolution of Cerebral Atherothrombosis
Atherosclerotic Cerebrovascular Disease and Inflammation
Risk Factors for Stroke
Mixed Cerebrovascular Disease
Treatment of Cerebrovascular Disorders
Treatment of Ischemic Stroke
Treatment of Hemorrhagic Stroke
Use of Stem cells in Treatment Cerebrovascular Diseases
Stem Cell Therapies for Cerebrovascular Diseases under Clinical Trails
Advantages of Stem Cell Therapy to Patients
Summary
References
Chapter 17
Immunobiology of Stroke
Abstract
Brain Immune Interactions
Brain-Immune Interactions and Ischemic Stroke
Immune Activation and the Risk of Stroke
Immune Signaling during Acute Infarction
Inflammatory Signaling in the Early Post-Ischemic Period
Ischemic Cell Death Activates Innate Immunity and Sets the Stage for Adaptive Immunity
ATP and Neurotransmitters
Cell Death and Pattern Recognition Receptors in the Post-Ischemic Brain
Does a Classical Adaptive Immune Response Contribute to Ischemic Brain Injury?
Stroke and Adaptive Immunity
The Lymphocyte Puzzle
Resolution of Inflammation and Tissue Repair
Clearing Dead Cells
TGFβ, IL-10 and the Anti-Inflammatory Milieu
Growth Factors
Stroke and Systemic Immunity
Bright and Dark Sides of Post-Stroke Immunosuppression
Bench to Bedside: Trials, Tribulations and Therapeutic Opportunities
Anti-Inflammatory Agents
Immunomodulation and T-Cell Based Approaches
Fighting Inflammation: A Double-Edged Sword?
The Role of Innate Immunnity after Stroke
Innate Immune System
The Role of Innate Immune System in Stroke
Initiation of Innate Immune Response: DAMPs and Pattern
Recognition Receptors
Activation of Innate Immune System
Activation of Local Resident Microglia in Central Nervous System
Infiltration of Immune Cells from Peripheral Blood Monocytes/Macrophages Accumulation
Neutrophil Infiltration
Dendritic Cell Increment
Dual Roles of Innate Immune System Cells
Microglia
Macrophages
Neutrophils
Dendritic Cells
Cytokines
Attempts and Difficulties in Bench-to-Bedside Translation
The Role of Adaptive Immunity after Stroke
Resolution of Inflammation and the Role of the Immune System in Tissue Repair
Brain Injury and Immunosuppression
Relationship between Poststroke Immunodepression and Adaptive Immunity
Immune Response to Acute Stroke
Innate Immune Response after Stroke
Damage-Associated Molecular Patterns
Innate Immune Receptors
Monocytes
The Complement System
Adaptive Immune Response After Stroke
Cytotoxic Effects
Effector T Cells
Autoreactive Responses
Cytoprotective Effects
Regulatory T Cells
B Cells
An Integrated Immune Response
Stroke-Induced Immunodepression
Neuroprotection by Antibiotics
Role of T Cells in Ischemic Stroke
T-Lymphocyte Subtypes and Characteristics
Potential Mediators of Damage by T Lymphocytes After Stroke
Cytokines, Chemokines, and Cytotoxins
Reactive Oxygen Species
Mechanism(s) of T-Lymphocyte Activation after Stroke
T-Lymphocyte-Targeted Experimental Therapies Anti-a4 Integrin Antibody
Anti-Vascular Cell Adhesion Molecule-1 Strategies
FTY720
FK506 and Cyclosporin A
RTL551
Chemokine Receptor Antagonists
Evidence for T Lymphocyte Involvement in Brain Regenerative Processes after Stroke
Summary and Conclusion
References
Chapter 18
Natural Herbs, Human Brain and Neuroprotection
1Department of Bioresources, Faculty of Biological Sciences, University of Kashmir, Srinagar-190006, India
Abstract
Introduction
Herbs that affect the functioning of Human Brain and provide neuroprotection
Targets for Neuroprotection in Stroke
Oxidative Stress as a Target for Neuroprotection in Stroke
Natural Compounds with Anti-Oxidative Properties
Inflammation as a Target for Neuroprotection
Natural Compounds with Anti-Inflammatory Effects
Apoptosis as a Target for Neuroprotection
Natural compounds with anti-apoptotic effects
Excitotoxicity as Target for Neuroprotection
Natural compounds with calcium antagonization (Excitotoxicity)
Blood-Brain Barrier Disruption as a target for neuroprotection
Benefits of Combination Therapy for Neuroprotection in Stroke
Neuroprotective Treatments with Pleiotropic Effects
Neuroprotective Agents in Human Clinical Stroke Trials
Citicoline Trial on Acute Stroke (ICTUS)
Summary
Polyphenols in Neuroprotection
Phenolics
Polyphenols
Protective Role of Polyphenols in Neuronal Ischemic Injury
Role of Polyphenols in Attenuating Oxidative Stress and Mitochondrial Dysfunction in Brain Edema and Cell Swelling
Role of Polyphenols in Preventing Neuroinflammation
Neuroprotection by Polyphenols in Hypoxic-Ischemic Injury in Neonates
Summary
References
Chapter 19
Natural Herbs in Stroke Prevention and Treatment
Abstract
Introduction
Approaches for Prevention and Treatment of Stroke
Importance of Traditional Medicine
Stroke Therapy in Traditional Medicine
Neuroprotection by Individual Herbs and Their Compounds
Natural Herbs Extracts and Their Active Compounds
Ginkgo Biloba
Scutellaria Baicalensis
Pueraria Thunbergiana, P. Lobata
Magnolia Officinalis
Angelica Gigas, A. Sinensis
Salvia Miltiorrhiza
Acanthopanax Senticosus
Panax Ginseng
Gardenia Jasminoides
Paeonia Suffruticosa, P. Lactiflora
Coptis Japonica
Camellia Sinensis (Green Tea)
Huperzia Serrata
Acorus Gramineus
Carthamus Tinctorius
Bombycis Corpus
Menispermum Dauricum
Cnidium Officinale, Ligusticum Chuanxiong
Rhodiola Rosea
Schisandra Chinensis
Corydalis Yanhusuo
Phellodendri Cortex
Uncaria Rhynchophylla
Gynostemma Pentaphyllum
Spiraea Japonica
Dioscoreae Rhizoma
Withania Somnifera
Curcumin
Future Directions
References
Chapter 20
Polyphenols from Natural Herbs in Neuroprotection
Abstract
Role of Polyphenols in Neuroprotection
Phenolics and Polyphenols
Protective Role of Polyphenols in Neuronal Ischemic Injury
Role of Polyphenols in Attenuating Oxidative Stress and Mitochondrial Dysfunction
Oxidative Stress and Mitochondrial Dysfunction are Key Features of Cerebral Ischemia
Role of Polyphenols in Preventing Neuroinflammation
Neuroprotection by Polyphenols in Hypoxic-Ischemic Injury in Neonates
Summary
References
Chapter 21
Recession, Skills and National Development: The South African Case
Abstract
Introduction
National Development Challenges in South Africa
Recession and Its Impacts: The South African Story
Impact of the Crisis
Equity Implications
National and Firm-Level Responses to the Crisis: Skills and its Impacts
National-Level Responses
Firm-Level Responses
Conclusion
References
Chapter 22
Foreword Advances and Challenges in Stroke: How Are Modern Techniques Changing Our Understanding of Stroke?
Introduction
Chapter 23
Monogenic Diseases Associated with Stroke
Abstract
Introduction
Small-Vessel Diseases (SVD)
Cerebral Autosomal Dominant (and Recessive) Arteriopathy with Subcortical Infarcts and Leukoencephalopathy
Fabry Disease
Other Rare Autosomal Dominant Small-Vessel Diseases
Homocystinuria
Stroke-Like Episodes
Mitochondrial Diseases
Familial Hemiplegic Migraine
Disorders of the Connective Tissue
Marfan Syndrome
Vascular Ehlers-Danlos Syndrome
Pseudoxanthoma Elasticum
Other Monogenic Diseases
Sickle Cell Disease
Hereditary Hemorrhagic Telangiectasia
Conclusion
References
Chapter 24
Fabry Disease: An Introduction for Neurologists
Abstract
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Manifestations (Table 1)
Skin and General Manifestations
Systemic Disease Manifestations
Neurologic Findings
Sensory Organ Abnormalities
Gastrointestinal Changes
Organ Damage
Stroke
Other Manifestations
Diagnosis/Differential Diagnosis
Prognosis and Clinical Course
Treatment (Table 2)
Therapies Directed at Other Organ Systems [42, 43]
Specific Therapeutics: Enzyme Replacement Therapy
New Treatments
References
Chapter 25
Pathogenesis of Hemorrhagic Stroke
Abstract
Introduction
Risk Factors
Neuroimaging Markers
Pathological Findings and Pathophysiology
Primary Injury
Secondary Injury
Causes of ICH
Spontaneous ICH
Deep Perforating Vasculopathy
Cerebral Amyloid Angiopathy
Secondary ICH
Cerebral Arteriovenous Malformations (AVM)
Cavernous Malformations (CMs)
Moyamoya Disease (MMD)
Genetics of ICH
Single-Gene Disorders
Cerebral Cavernous Malformation (CCM)
Hereditary Hemorrhagic Teleangiectasia (HHT)
Hereditary Cerebral Amyloid Angiopathy (H-CAA)
1) APP-Related CAA (OMIM 605714-104760)
2) Cystatin-Related (CST3), Icelandic Type, CAA (OMIM 105150-604312)
3) TTR-Related CAA (OMIM 105210)
COL4A1 Syndrome (OMIM 605595-120130)
Candidate Gene Variants Associated with Intracerebral Hemorrhage
Vessel Wall Integrity
ACE (Locus 17q23) and α-ADDUCIN (Locus 4p16.3)
Coagulation System
Factor V Leiden (Locus 1q23) and Prothrombin 20210A (Locus 11p11-q12)
Factor VII (Locus 14q34)
Factor XIII (Locus 6p25.1)
Serpin 3 (Locus 14q32.1)
MTHFR (Locus 1p36.3)
Inflammatory Markers
TNF (6p21.3 Locus)
IL-4 (Locus 5q31.1)
IL-6 (Locus 7p15.3)
ALOX5AP (Locus 13q12.3)
Complement Cascade
PDGF-D (Locus 11 q22.3)
TP53 (Locus 17 p13.1)
Tubulin β1 (Locus 20b q13.32)
CR1 (Locus 1q32.2)
References
Chapter 26
Animal Models of Stroke: Present and Future
Abstract
Introduction
Vessel Occlusions
Global Ischemia
Focal Ischemia
Limits to the Models
References
Chapter 27
The Added Value of Neurosonology: A Tax-Free Genius in the Probe
Abstract
Introduction
Carotid Stenosis: From Degree Quantification to Plaque Characterization
Assessment of Plaque Morphology and Haemodynamic Effect
Assessment of Plaque Vulnerability
Hyperacute Revascularization: From Detection of Occlusion to Sonothrombolysis
Diagnosis and Monitoring: The TIBI Score
From Diagnosis to Treatment: Sonothrombolysis
References
Chapter 28
Intravenous Thrombolysis: Present Evidences and Future Perspectives
Abstract
Introduction
Intravenous Thrombolysis
Newer Thrombolytic Agents: Desmoteplase, Tenecteplase
Thrombolysis in the Elderly
Influence of Gender
Neuro-Imaging Techniques Contribution
Thrombolysis in Special Conditions
References
Chapter 29
Haemorrhage: Emerging Therapies
Abstract
Introduction: Causes and Natural History
Treatment
Medical Treatment
Medical Care and Management of Complications
Surgical Treatment
Intracerebral Haemorrhage during Anticoagulant Therapy
Antagonists
Direct Oral Anticoagulants (DOACS)
Monitoring the Anticoagulant Activity of DOACS
Dabigatran Reversal Agents
Rivaroxaban Reversal Agents
Apixaban and Edoxaban Reversal Agents
Therapeutic Strategies Underway
References
Chapter 30
Management of Intracranial Stenosis
Abstract
Introduction
Epidemiology and Pathology
Therapeutic Strategies
Medical Therapy
Risk Factor Controls
Surgical Treatment
Endovascular Treatment
Alternative Perspectives
References
Chapter 31
“Telestroke,” a Frontier in the Globalization Era
Abstract
Introduction
History
The Beginning of Telemedicine
The Development of Telestroke
Implementations
Technology Issues
Organizational Elements of Telestroke Networks
Telestroke-Associated Clinical Process of Care
Prehospital Telestroke
Telemedicine in Stroke Rehabilitation
Motivations for Implementing Telestroke Programs
Barriers to the Initiation, Growth and Sustainability of Telestroke Programs
Clinical Effectiveness
Participants
Cost-Effectiveness and Reimbursement Models
Macroeconomic Cost-Effectiveness of Telestroke Networks
Reimbursement Models of Hub Hospitals
Problems and Limitations in Telestroke
Quality of Service
Technical Problems
Non-Stroke-Telemedicine
US-Specific Problems – Licensing and Accreditation
Perspectives
Discarding the “Ship and Drip” Model
Non-Stroke-Telemedicine
The E-Stroke Unit
References
Chapter 32
Imaging in Acute Stroke
Abstract
Introduction
Noncontrast Computed Tomography (NCCT)
Magnetic Resonance Imaging (MRI)
CT Angiography (CTA)
MR Perfusion
CT Perfusion (CTP)
Role of Advanced Imaging in Stroke: Limitations
Role of Advanced Imaging in Stroke: What We Learn from the Trials in 2015
Role of Advanced Imaging in Stroke: Future Perspective
Conclusion
References
Chapter 33
Stroke and Atrial Fibrillation
Abstract
Introduction
Clinical Impact of Atrial Fibrillation
Therapeutical Issues
Anticoagulation Therapy
Aspirin Monotherapy or in Combination with other Agents
New Oral AntiCoagulant Drugs
Non Pharmacological Interventions
Rhythm Control: Drugs and Radiofrequency Catheter Ablation
Conclusion
References
Chapter 34
Subclinical Atrial Fibrillation (SCAF) and Embolic Stroke of Undetermined Source (ESUS)
Abstract
Introduction
Subclinical Atrial Fibrillation (SCAF) and Cryptogenic Ischemic Stroke (CIS): Data and Challenges
Detection of SCAF: Try and Catch It!
SCAF and Stroke Pathogenesis: Cause or Marker?
Device-Detected SCAF and Therapy: To Anticoagulate or Not to Anticoagulate?
Embolic Stroke of Undetermined Source (ESUS): A New Pragmatic Clinical Construct
Conclusion
References
Chapter 35
Direct Oral Anticoagulants in Patients with Atrial Fibrillation
Abstract
Introduction
General Overview of Direct Oral Anticoagulants
Efficacy and Safety in Stroke Prevention
Pharmacological Aspects
Contraindications
Adherence Issues
Presence of Comorbidities
Chronic Kidney Disease
Acute Coronary Syndromes
Elderly Patients
Reversal Strategies and Management of Bleedings
Switching between Anticoagulants
Management in Case of Planned Cardioversion
Management in Case of Planned Surgical Interventions
DOACs from Neurologist’s Perspective
Secondary Prevention of Ischemic Stroke in Patients with Atrial Fibrillation
Adherence Issues in the Elderly and in Patients with Cognitive Impairment
The Acute Phase of Stroke
Ischemic Stroke Recurrences during Treatment with DOACs
Acute Intervention Strategies
Implementation of Secondary Prevention Strategies after their Failure in Preventing Recurrences
Intracranial Hemorrhage
Clinical and Neuroimaging Tools to Stratify Hemorrhagic Risk
Restarting DOACs after Intracerebral Hemorrhage
Conclusion
References
Chapter 36
Emerging Biochemical Risk Markers of Stroke
Abstract
Introduction
The Pathological Basis of Arterial Wall Inflammation
Inflammation and Thrombosis as a Source of Biomarkers
Oxidative Stress as a Possible Source of Biomarkers
Serum Gamma-Glutamyltransferase: A Prognostic Marker in Cardio - Vascular Diseases
Gamma-Glutamyltransferase Inside Plaques: Possible Connections with Serum GGT
References
Chapter 37
Mitochondria, Mitochondrial DNA and Stroke
Abstract
Introduction
Why Mitochondrion?
Overview of Mitochondrial Biology and Genetics
Mitochondrial Disease
MELAS, a Cerebrovascular Mitochondriopaty
The Vascular Cascade Leading to Ischemia/Reperfusion Injury during Acute Stroke Is Linked to the Mitochondrion: The ROS Strategy and the Oxygen Paradox
Targeting Mitochondria for Stroke Therapy. Preclinical Studies
Genetic Mitochondrial Variation and Stroke Susceptibility
Conclusion
References
Chapter 38
Cervical Artery Dissection: What’s New in 2015
Abstract
Introduction
“Environmental” Risk Factors and Vascular Comorbidities
Genetic Risk Factors
Monogenic Forms of CeAD
Complex Forms of CeAD
Treatment and Outcome
Conclusion
References
Chapter 39
New Insights in Ischemic Stroke: Role of Antioxidant Supplementation
Abstract
Abbreviations
Introduction
Risk Factors
Protective Factors
Pathophysiology
Oxidative Stress
Ischemia – Reperfusion
Apoptosis
Inflammation
Blood Brain Barrier Disruption
Edema formation
Oxidative Stress Biomarkers
non-antioxidant Acute Interventions for Stroke Management
Stroke Care Units (SCU)
Revascularization Techniques in the Acute care
Intravenous Thrombolysis
Intra-arterial Thrombolysis
Mechanical Thrombectomy
Anticoagulant and Antiplatelet Drugs
Non-pharmacologic Neuroprotection
Airway, Ventilatory Support and Oxygen
Temperature Management
Blood Pressure
Glucose Management
Pharmacological Neuroprotection
Albumin
Magnesium Sulfate
Hypothermia
Other Pharmacological Strategies
The Role of Acute Antioxidant Defense System Enhancement in Ischemic Stroke Treatment
Inhibition of ROS-producing Enzymes
NADPH Oxidase Inhibition
Allopurinol
Antioxidant Supplementation to Scavenge ROS
Vitamin C
Vitamin E
Resveratrol
N-acetylcysteine (NAC)
Other Antioxidant Strategies
Conclusions
References
Chapter 40
Mechanisms Underlying Ischemic Stroke Prevention by Tea (Camellia Sinensis)
Abstract
Introduction
Clinical Evidence of Antioxidant Effects
Molecular Mechanisms Underlying Antioxidant Effects
Clinical Evidence of Ischemic Stroke Prevention
Animal Models of Ischemia and Molecular Mechanisms
Clinical Evidence of Antihypertensive Effects
Clinical Evidence of Anti-Hypercholesterolemia Effects
Animal Models of Hypertension and Molecular Mechanisms
Mechanisms Underlying Effects in the Initiation and Propagation of Atherosclerosis
Effects of Tea Polyphenols on Inflammatory Cytokine Production in Atherogenesis
Effects of Tea Polyphenols on Vascular Endothelium Function
Mechanisms Underlying the Effects of Tea on Endothelial Function
Conclusions
References
Chapter 41
Neonatal Asphyxia and Stroke: Morbidity, Models, Consequences, and Treatments
Abstract
1. Introduction
1.1. Peri/Neo-Natal Hypoxia and Hypoxia Ischemia
1.1.1. Hypoxia Ischemia Prevalence and Risk Factors
2. Cellular Processes of Neuronal Death during Ischemia
2.1. Excitotoxicity
2.2. Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS)
2.3. Inflammation
3. Brain Regions Vulnerable to the Effects of Hypoxia Ischemia
3.1. Prenatal and Perinatal Hypoxia Ischemia
3.2. Neonatal Hypoxia Ischemia
4. Animal Models of Hypoxia Ischemia
4.1. Primate
4.2. Sheep and Pig
4.3. Rat and Mouse
5. Treatments
5.1. Current Clinical Treatments
5.1.1. Prevention: Pharmacological and Surgical Interventions
5.1.2. Rehabilitiation: Physiotherapy
5.1.3. Limiting Brain Damage: Pharmacological Intervention
5.1.4. Limiting Brain Damage: Hypothermia
5.2. Putative Pharmacological Treatments
5.2.1. Limiting Brain Damage
5.2.1.1. Inhibitors of CNS Excitation
5.2.1.2. Antioxidants
5.2.1.3. Anti-Inflammatory Drugs
5.2.2.Rehabilitation and Repair
5.2.2.1. Neural Plasticity
5.2.2.2. Neurogenesis
Conclusions
References
Chapter 42
Swallow Screening as an Essential Component of Acute Stroke Management
Abstract
Introduction
When to Screen and by Whom?
Screening Tools Available
Swallow Screening for all?
A Study of Swallow Screening Compliance
Methodology
Sample Size
Inclusion and Exclusion Criteria
Quality of Care Measures
Data
Data Analysis
Results
Description of Participants
Process Indicator Compliance
Variables associated with Swallow Screening Compliance
Accounting for Confounders
Discussion of Study Findings
Improving Compliance with Swallow Screening
Conclusion
Acknowledgment
References
Chapter 43
Analysis of Brain Function using Cerebral Blood Flow Measurements in Patients with Supratentorial Cerebral Strokes
Abstract
Introduction
Method
Subjects
CBF Measurement
Functional Independence Measure
Statistical Analysis
Result
Discussion
Conclusion
References
Chapter 44
The Rehabilitation Function of Motor Imagery after Peripheral Injury or Central Stroke
Abstract
Introduction: Motor Imagery and Motor Learning
Relationships between MI and Actual Execution
Conditions Required by MI Training during Motor Rehabilitation
Feedback Information during Actual Execution, MI and after Deafferenteation / Deefferentation
MI Treatment in Patients with Stroke
MI Treatment in Patients with Spinal Cord Injury
MI Treatment in Patients with Peripheral Injury (Joint Sprain, Muscle Tear, Bone Fracture)
General Conclusion
References
Chapter 45
Neuropsychological Issues in Stroke Rehabilitation
1Department of Physical Medicine and Rehabilitation
Temple University School of Medicine
2Department of Neuropsychology West Tennessee
Rehabilitation Center Jackson, Tennessee, US
Introduction
Definitions and Epidemiology
Types of Stroke
Major Arteries/Blood Supply to the Brain
Regional Syndromes Following Stroke
Aphasia
Fluent Aphasia
Nonfluent Aphasia
Pure Aphasia
Assessment of Aphasia and Recovery
Hemiparesis and Other Motoric Disorders
Apraxia
Neglect
Perceptual Disorders
Memory Disorders
Executive Functioning
Conclusion: Practical Aspects of Neuropsychology in Stroke Rehabilitation
References
Chapter 46
Effects of Walking Speeds and Normalization Methods on the Muscular Activity of the Paretic Lower Limb in Stroke Subjects
Abstract
Introduction
Methods
Subjects
Evaluation
Clinical Evaluations
Gait Evaluations
Electromyographic Data Processing
Statistical Analyses
Results
Subjects' Characteristics
Pattern Characteristics of the EMG Activity
Comparisons Between the Comfortable and Maximal Walking Speeds Considering the Methods of Normalization
Intra- and Inter-Subject Variability of the EMG Signal Amplitudes
Discussion
Pattern Characteristics of EMG Activity
Methods of Normalization
Interaction Effects Between Walking Speeds and Methods of Normalization
EMG Activity at Comfortable and Maximal Walking Speeds
Conclusions
Acknowledgments
References
Chapter 47
Cardiac Swinging Calcified Amorphous Tumors (SCAT) and Stroke in End-Stage Renal Failure
Abstract
Cases
Review
Conclusion
References
Chapter 48
Endovascular Treatment of Acute Ischemic Stroke
Introduction
Thrombectomy Devices
Merci Retriever (Concentric Medical, Mountain View, CA, U.S.)
Published Studies
Penumbra System® (Penumbra Inc., Alameda, CA, U.S.)
Published Studies
Solitaire™ Stent (Ev3, Irvine, CA, U.S.)
Procedure
Published Studies
Case Report 1
Trevo Pro® (Concentric Medical, Mountain View, CA, U.S.)
2.5 Catch Device® (Balt Extrusion, Montmorency, France)
Phenox Clot Retriever® (Phenox GmbH, Bochum, Germany)
Bonnet Intracranial Flow Restoration Device® (Phenox GmbH, Bochum, Germany)
Case Report 2
pRESET Thrombectomy Retriever® (Phenox GmbH, Bochum, Germany)
Case Report 3
Current Studies In Stent Thrombectomy Devices
Direct Stent Placement
Published Studies
Case Report 4
Case Report 5
Endovascular Sono-Lysis—EkoSonicTM Endovascular System (EKOS Corporation, Bothell, WA, U.S.)
Published Studies
Case Report 6
Other Experimental Devices EPAR®—Endovascular Photoacoustic Recanalization (Endovasix Inc., Belmont, CA, U.S.)
Studies
ReviveTM SE Blood Clot Retrieval® (Codman and Shurtleff, Inc., Johnson and Johnson Company, Raynham, MA, U.S.)
Penumbra Separator™ 3d® (Penumbra, Alameda, CA, U.S.)
Mindframe Capture LP® (Mindframe Inc., Irvine, CA, U.S.)
Acandis APERIO® System (Acandis Gmbh and Co. KG, Pforzheim, Germany)
Possis Angiojet System® (Possis Medical, Minneapolis, MN, U.S.)
Latis Laser Device® (Spectanetics, Colorado Springs, CO, U.S.)
Amplatz Goose-Neck Microsnare® (Ev3 Medical, Plymouth, MN, U.S.)
Attracter-18™ (Boston Scientific/Target Therapeutics, Fremont, CA, U.S.)
Neuronet™ Guidant Device® (Guidant Corp, Temecula, CA, U.S.)
In-Time™ Retrieval Device® (Boston Scientific, Boston, MA, U.S.)
Interventional Procedure Technique
Conclusion
Acknowledgment
References
Chapter 49
Metabolic Syndrome, Subclinical Carotid Atherosclerosis and Risk of Stroke: How Strong Is the Link?
1Department of Neurology, Miller School of Medicine,
University of Miami, Miami, FL, US
2Department of Laboratory Medicine and Advanced Biotechnologies,
IRCCS San Raffaele, Rome, Italy
Abstract
1. What is Metabolic Syndrome?
2. Metabolic Syndrome and Risk of Stroke and Diabetes
Metabolic Syndrome and Risk of Stroke
Metabolic Syndrome and Risk of Diabetes
3. Metabolic Syndrome and Race-Ethnicity
4. Subclinical Carotid Atherosclerosis and Risk of Stroke and Cardiovascular Disease
Carotid Intima Media Thickness (cIMT) and Risk of Stroke and CVD
Carotid Plaque (CP) and Risk of Stroke and CVD
Arterial Stiffness (STIFF) and Risk of Stroke and CVD
5. The Link between Components of Metabolic Syndrome and Subclinical Carotid Atherosclerosis
Hypertension and Subclinical Carotid Atherosclerosis
Glucose Homeostasis and Subclinical Carotid Atherosclerosis
Dyslipidemia and Subclinical Carotid Atherosclerosis
Obesity and Subclinical Carotid Atherosclerosis
6. Link between Metabolic Syndrome and Subclinical Carotid Atherosclerosis
7. Subclinical Carotid Atherosclerosis as Potential Marker to Risk-Stratify People with Metabolic Syndrome
References
Chapter 50
Conjugated Linoleic Acids in the
Prevention of Ischemic Stroke
Abstract
List of Abbreviations
Introduction
Observational Evidence
Effects on Mediators of Inflammation
Anti-Atherosclerotic Effect of Linoleic Acids and Molecular Pathways
Antithrombotic Effects of Linoleic Acids
Antihypertensive Effects
Conclusion
References
Chapter 51
From Knowledge to Practice: Sustaining Community Engagement in Secondary Stroke Prevention
Abstract
Introduction
Self-Management approach in Secondary Stroke Prevention: A Paradigm Shift
The Development of a Self-Management Educational Programme for Minor Stroke Patients
Performance Accomplishments
Vicarious Experience
Verbal Persuasion
Interpretation of Physiological Information
Establishing Evidence-Based Practice in Community-Based Secondary Stroke Prevention Initiatives for Patients with Minor Stroke
Method
Results
Translating Research Evidence into Community Practice in Secondary Stroke Prevention for Minor Stroke Patients
Promoting Patients’ uptake and Participation
Timing
Knowledge and Skills Transfer
Experiential Learning and Feedback
Peer Support
Sustaining Community Engagement through Transdisciplinary Collaboration
Transdisciplinary approach in Patient Empowerment
Hospital-Community Interfacing
Conclusion
References
Chapter 52
Risk of Stroke and Death with Antipsychotics in Dementia Patients
Abstract
Introduction
1. Cerebrovascular Adverse Events (CVAEs)
A. Randomized Controlled Trials
B. Pooled & meta-analyses and systematic reviews
C. Other Studies
Risk of death
A. Randomized placebo controlled trials
B. Meta-analysis and systematic review
Table 2. Summary of data from pooled analyses, meta-analyses and systematic reviews
C. Population based studies, retrospective analyses and other studies
Table 3. Summary of data from other studies
Summary
Conclusion
References
Chapter 53
Ultrasound in the Management
of Ischemic Stroke
Abstract
Introduction
Why Ultrasound
Clinical Cerebrovascular Anatomy and Physiology
Imaging Modalities, Instrumentation and Indices
Safety
Performing an Extracranial Triplex Examination
Performing a Transcranial Triplex Examination
Performing a Transcranial Doppler (TCD) Examination
Clinical Applications
Intimamedial Thickness
Extracranial Arterial Stenosis/Occlusion
Non-Atherosclerotic Disease - Carotid Dissection, Takayasu Disease, Radiation-Induced Atherosclerosis
Subclavian Steal
Intracranial Arterial Stenosis/Occlusion
Collateral Flow As a Result of Severe Stenosis/ Occlusion
Right-To-Left Shunting
Embolisation
Intra-Operative Monitoring during Carotid Endarterectomy (CEA), Coronary Artery Bypass Grafting (CABG)
Post-Surgery/Stent Assessment
Cerebrovascular Reserve to Predict Stroke Risk
Sonothrombolysis
Physician Accreditation
Conclusions
References
Chapter 54
Modeling and Optimal Design of Power High Stroke Piezoelectric Actuators for Rotorcraft Applications
Abstract
1. Introduction
2. Finite Element Modeling of Flextensional Actuator with Elliptic Shell
3. GA Based Optimization of the Shell Geometry
4. Results and Discussion
Conclusion
Acknowledgments
References
Chapter 55
Combination Treatment of Repetitive Transcranial Magnetic Stimulation and Intensive Occupational Therapy: A Novel Therapeutic Approach for Upper Limb Hemiparesis After Stroke
Abstract
Introduction
Therapeutic Concept of rTMS Combined with Intensive OT for Upper Limb Hemiparesis After Stroke
Low-Frequency rTMS As a Therapeutic Tool
Combined Application of Low-Frequency rTMS and Intensive OT
In-Patient Protocol of Combination Treatment
Inclusion Criteria
Time Schedule of 15-Day Protocol
Application of Low-Frequency rTMS
Rehabilitative Program of Intensive OT
Clinical Evaluation of Upper Limb Motor Function
Clinical Results
Clinical Features of Studied Patients
Safety and Feasibility of the Protocol
Treatment Outcome on Motor Function of the Affected Upper Limb
Baseline Features Affecting Treatment Outcome
Future Directions in Research and Clinical Practice
Concomitant Administration of Levodopa
Pre-Treatment Injection of Botulinum Toxin Type A
Application of More Potent TMS Modalities for Neuromodulation
Conclusion
References
Chapter 56
Evidence for C-Reactive Protein as A Prognostic Indicator for Ischaemic Stroke Risk
Abstract
Introduction
Methods
Subjects and Inclusion Criteria
Blood Sampling and Determination of CRP Levels
Carotid Ultrasonography
Statistical Analysis
Ethics
Results
Discussion
References
Chapter 57
The Growing Prevalence of Atrial Fibrillation, Especially on Stroke Units
Abstract
Introduction
Prevalence of Cardioembolism in Stroke Units
A Single Centre Experience
Future Perspectives
References
Chapter 58
N-Terminal Probrain Natriuretic Peptide as a Biomarker of Cardioembolic Stroke
1Department of Neurosciences - Neurology,
Santa Maria Hospital, Lisbon, Portugal
Abstract
Introduction
Brain Natriuretic Peptide and N-Terminal Probrain Natriuretic Peptide
NT-ProBNP in Acute Ischemic Stroke
Conclusion
References
Chapter 59
From Cryptogenic Stroke to Paroxysmal Atrial Fibrillation
Abstract
Introduction
Paroxysmal atrial fibrillation (PAF)
Features That Support the Suspicion of a Cardioembolic Etiology Due to PAF in Cryptogenic Stroke
A – Absence of a More Plausible Etiology for the Stroke
A1 – Exclusion of a «vascular etiology»
A2 – Exclusion of Other Causes
B - Clinical Features
C – Cardiac Findings
C1- Electrocardiography
C2- Echocardiography
D- Neuroimaging Findings
Conclusion
References
Chapter 60
Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation
Abstract
Introduction
Why Do Patients With AF Have a Higher Risk of Stroke and Why is There a Need for Anticoagulation?
Warfarin vs. Antiplatelet Agents in AF
Aspirin Use in Stoke Prevention in Patients with AF
Dual Antiplatelet Therapy for Stroke Prevention in Patients with AF
Thromboembolic risk stratification in patients with AF
Disadvantages of Anticoagulation with Warfarin
The Ideal Warfarin Replacement
Novel Oral Anticoagulants
Dabigatran Etexilate
Rivaroxaban
Apixaban
When Warfarin is not an Option
Apixaban Use in Patients with a High Risk of Thromboembolism and Bleeding
Oral Anticoagulation And Bleeding Risk, Can We Predict The Individuals Who Will Bleed?
Concerns about the Use of Novel Oral Anticoagulants
So What Shall I Do Doctor?
Case 1
A 78-year-old man with hypertension, diabetes and AF has been on warfarin for four years. He is stable with an INR in therapeutic range >80% of the time. He requires blood monitoring every 4-6 weeks and is happy with the necessary dietary restrictions...
Case 2
A 45-year-old man with no risk factors for thromboembolism is scheduled to undergo electrical cardioversion.
Case 3
An 88-year-old woman with AF, partially sighted with previous TIA, hypertension and peripheral vascular disease who lives alone in an area with no easy access to a clinic or community practitioner to monitor INR. Her time in therapeutic range for the ...
Case 4
tolerated warfarin, aspirin and clopidogrel for 12 months and currently, following the advice from the interventional cardiologist, takes aspirin and warfarin. Her time in therapeutic INR is 60-70%.
Case 5
A 67-year-old man with hypertension, diabetes and asymptomatic permanent AF. He refuses to consider warfarin and has been on aspirin monotherapy for seven years.
Conclusion
References
Chapter 61
Stroke in Elderly
Bezmialem Vakif University, Faculty of Medicine, Department of Neurology Istanbul/Turkey
Abstract
Stroke Is a Geriatric Disease
Preventable Stroke
Large Vessel Disease
Asymptomatic Carotid Artery Disease
Cardioembolic Strokes
Lacuner Strokes
Treatment of Stroke
Pathophysiology
The Treatment of Acute Ischemic Stroke
References
Chapter 62
Troponin and Acute Stroke
1 School of Medicine, Gold Coast Campus, Griffith University, Australia
2 Department of Cardiology Gold Coast University Hospital, Southport Queensland, Australia
3 Department of Neurology, Gold Coast University Hospital, Southport Queensland, Australia
Abstract
1. Introduction
2. Methods
2.1. Review of the Literature
2.2. Statistical Analysis
3. Troponins
3.1. Troponin Structure, Function and Metabolism
3.2. Troponins As a Marker of Cardiac Ischaemia
3.3. Troponins As a Marker of Other Pathologies
3.2.1. Sepsis and Septic Shock
3.2.2. Pulmonary Embolism
3.2.3. Cardiac Failure
3.2.4. Renal Failure
4. Troponins in Stroke
4.1. Clinical Associations of Troponin Elevation in Acute Stroke
4.2. Troponin and Other Markers of Cardiac Disease in Acute Stroke
4.2.1. Serological Markers
4.2.1. ECG Findings
4.2.1. Echocardiography
4.3. Troponin and Lesion Characteristics in Acute Stroke
4.4. Troponin As an Outcome Predictor in Acute Stroke
5. Mechanisms of Troponin Rise in Acute Stroke
5.1. Myocardial Infarction
5.2. Renal Failure
5.3. Infective Endocarditis
5.4. Pulmonary Embolism
5.5. Serious Arrhythmias
5.6. Cardiac Failure
5.7. Other Possible Causes of Troponin Rise in Acute Stroke
5.7.1. Atrial Fibrillation
5.7.2. Takotsubo Cardiomyopathy
5.8. Stroke and the Autonomic Nervous System
5.9. Mechanistic Summary
6. Treatment Implications
Conclusion
References
Chapter 63
How Could Fluoxetine Exert Therapeutic Effects in Stroke?
Pharmacologie de la circulation cérébrale EA4475, Université Paris Descartes, Paris
Abstract
1. Introduction
1.1 The Neurovascular Unit and the Cerebral Blood Flow
Figure 1. The principal elements constituting the neurovascular unit.
1.2 Stroke and Cerebral Ischemia
1.3 Cellular Consequences of Brain Ischemia: Glutamate-Induced Excitotoxicity, Oxidative Stress and Inflammation
1.4 Brain Remodeling after Cerebral Ischemia
2. Experimental and Clinical Stroke Therapeutic and the Acute Effects of Fluoxetine
2.1 Drugs Acting on Haemostasis
2.2 Drugs Promoting Vasodilation and Blood Reperfusion
2.3 Drugs Preventing Cellular Damages
3. Antidepressant-Like Effects of Fluoxetine in Post-Stroke Depression
3.1 Chronic Fluoxetine Increases Post-Synaptic 5-HT1a Receptor-Mediated Neurotransmission
3.2 Chronic Fluoxetine Alters Trophic Factors and Cell Proliferation
4. Conclusion and Perspectives
5. References
Chapter 64
Correlation Between Executive and Motor Function in Patients after Stroke
Abstract
Introduction
Organization of Neuropsychological Functions Responsible for Planning and Organizing Activities - Executive Functions
Neurobiological Basis of Executive Functions
Functional Organization of the Frontal Lobes
Basic Executive Functions
The Concept of Executive Functions
The Role of Executive Functions in Motor Activity and Walk
Biomechanics of Human Movement and Characteristics of Effective Walking
Kinematic Walk Analysis
Walk Parameters
Locomotor Activity and Movement Control
Balance and Balance Disorders
Motor Functions and Walk in Patients After a Stroke
Problem and Objective
Research Methodology
Research Instruments:
Wisconsin Card Sorting Test - WCST
Trail Making Test - TMT A/B
Mini Mental State Examination - MMSE
Functional Ambulation Category - FAC
Step Test
Functional Independence Measure - FIM
Research Results
General Characteristics of the Sample Survey Results
Discussion
Conclusion
Literature
Chapter 65
Diagnosis and Management of Language Impairment in Acute Stroke
1Department of Neurology, Centre Hospitalo-Universitaire de Bicêtre,
Assistance Publique – Hôpitaux de Paris, Le Kremlin Bicêtre, France
2Department of Speech Language Pathology, University of Toronto, Canada
3Department of Neurology, Salpêtrière Hospital, Assistance - Publique Hôpitaux
de Paris, Paris, France
4PARIS Sud XI University, France
5INSERM 4788, Le Kremlin Bicêtre, France
Abstract
Introduction
1. Impairments in the Acute Phase of Stroke: Generalities
1.1. Definitions
1.2. Incidence, Predictors and Phenotypes of Language Impairment
1.3. Prognosis
2. Tools for Language Assessment
2.1. Available Tools
2.2. A Novel Tool: LAST, the Language Screening Test
3. Recovery
4. Rehabilitation
5. Perspectives
Conclusion
References
Chapter 66
Socio-Economic Burden of Myocardial Infarction and Stroke Attributed to Road Traffic Noise in Europe
Abstract
1. Introduction
2. Methods
2.1. Burden of Disease Estimation
2.2. Noise Exposure
2.3. Risk Estimates
2.4. Morbidity, Mortality and Life Expectancy
2.5. Disability Weights and Duration of Disability
2.6. Monetary Valuation
3. Results
4. Discussion
4.1. Strengths and Limitations
Conclusion
Disclosure Statement
References
Chapter 67
Study of Two Stroke Techniques with Transverse Movement of the Right Hand on Classical Guitar Using Surface EMG
Abstract
Introduction
Method
Results and Discussion
Participant 1
Participant 2
Conclusion
References
Chapter 68
Nystagmus in Posterior Fossa Stroke Patients
Introduction
Pathophysiological Mechanisms of Central Nystagmus Generation.
Gaze Holding
Yaw, Roll and Pitch Plane
Roll Plane
Pitch Plane
Flocculus
Bedside Examination
Skew Deviation
The Vestibulospinal Tests
Methods
Results
Therapy
Discussion
Acknowledgments
References
Chapter 69
Eating Habits, Falls and Stroke Risk
Introduction
Material and Methods
Participants
Data Analysis
Study Limitation
Results
Discussion
Conclusion
References
Chapter 70
Effects of Physical Exercise Following Ischemic Stroke: Is Timing an Important Factor?
Abstract
Introduction
Exercise Rehabilitation Today
Current Models of Exercise-Mediated Recovery in Clinical Setting
Clinical Evidence-Based Effects of Early Exercise on Stroke Outcome
Effects of Late Exercise and Other Factors in a Clinical Setting
Translating Animal Studies to Human Disease
Current Debate on the Optimal Use of Exercise
How Early Is Early Exercise
Early Exercise May Be Good or Bad
Late Exercise in Rat Models
Molecular and Physiological Basis of Early Exercise-Mediated Recovery
Neuroprotective Capacity of Early Exercise and Its Potential Role in Rehabilitative Functional Recovery
Exercise and Neuroplasticity: Synaptogenesis, Neurogenesis, and Angiogenesis
Conclusion
References
Chapter 71
Stroke and Traumatic Brain Injury
Stroke
Anterior Circulation
Posterior Circulation
Circle of Willis
High Yield Stroke Facts
Deficits in Stroke
Sensory
Visual
Behavioral
Stroke Syndromes
Anterior Cerebral Artery (ACA) stroke
Middle Cerebral Artery (MCA) stroke
Common or Internal Carotid Artery (ICA) stroke
Midbrain Stroke (Weber’s)
Pons Stroke
Lateral Medullary Stroke (Wallenberg)
Posterior Inferior Cerebral Artery (PICA) Stroke
Locked in Syndrome
Vascular Dementia
Transient Ischemic Attack
Anterior TIA: carotid origin
Posterior TIA
Traumatic Brain Injury
Basics
Epidural Hematoma
Subdural Hematoma
Subarachnoid Hemorrhage
Transtentorial Herniation
Normal Pressure Hydrocephalus
Creutzfeldt-Jakob Disease
Subacute Sclerosing Panencephalitis (SSPE)
Wernicke (reversible)-Korsakoff (irreversible)
References
Chapter 72
Virtual Exercises to Promote Cognitive Recovery in Stroke Patients
Abstract
Introduction
Methods
Measures
Procedure
Results
Discussion
Acknowledgments
References
Chapter 73
Automatic Non-Contact Categorization of Upper Body Motion Impairments and Common Post-Stroke Motion Synergies
Abstract
Introduction
Objectives
Contributions
Methods
Experimental Dataset
Considerations of Tracking Accuracy
Automatic Categorization of Motion Impairments
Assessing the Skeleton Tracking in Impaired Motions
Findings
Verifying a Tracking Bias
Discussion
Acknowledgments
References
Chapter 74
Patient Engagement and Clinical Feasibility of Augmented Reflection Technology for Stroke Rehabilitation
Abstract
Introduction
Methods
System and Clinical Setting
Participants
Procedure and Experimental Design
Nonclinical Measures
Results and Discussion
Conclusion
Acknowledgments
References
Chapter 75
Combining Virtual Reality and a Myoelectric Limb Orthosis to Restore Active Movement after Stroke
1Universidade da Madeira, Campus Universitário da Penteada,
Funchal, Portugal,
2Myomo, Cambridge, Massachusetts, United States of America and
3University of Pittsburgh, Pittsburgh, Pennsylvania, US
Abstract
Introduction
Our Study
Limb Orthosis
Tracking
Virtual Environment
Pilot Evaluation
Findings
Discussion
Acknowledgments
References
Chapter 76
Childhood Vasculitic Stroke
Abstract
Overview
Vascular Patterns of Stroke
Arterial Involvement
Venous Involvement
Stroke Classification
Nosology and Classification of Vasculitis
Primary Vasculitides
Large Vessel Vasculitis
Medium Vessel Vasculitis
Small Vessel Vasculitis
Variable Vessel Vasculitis
CNS Vasculitis
Large-Medium Vessel Type
Small Vessel Type
Secondary Vasculitides
Connective Tissue Disorders
Infection
Diagnostic Work Up
Differential Diagnosis
Serologic Studies
Cerebrospinal Fluid Analysis
Neuroimaging
Diagnostic Tissue Pathology
Treatment
Conclusions
References
Chapter 77
Stroke Due to Vasculitis in Adults
Abstract
Introduction
Primary CNS Vasculitis
Primary Large Vessel Vasculitis
Primary Medium Vessel Vasculitis
Primary Small Vessel Vasculitis
Anca-Associated Vasculitis
Granulomatosis with Polyangiitis
Microscopic Polyangiiits
Eosinophilic Granulomatosis with Polyangiitis
Immune Complex Vasculitis
Cryoglobulinemic Vasculitis
Hypocomplementemic Urticarial Vasculitis/C1q
References
Chapter 78
Stroke and Pulmonary Embolism Outcomes or Complications Associated with ICD Device Implantation
Abstract
Introduction
Device and Thrombogenic Risk
Device and Patent Foramen Ovale
Other Risk Factors
Management
Conclusion
References
Chapter 79
Stroke
1Tsinghua University Yuquan Hospital, Beijing, China
2Medical Center, Tsinghua University, Beijing, China
3Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
4Beijing Hongtianji Neuroscience Academy, Beijing, China
1. Overviews
1.1. Incidence
1.2. Risk factors
1.3. Pathophysiology
1.4. Treatment
1.4.1. Management of Acute Phase of Intracerebral Haemorrhage
1.4.2. Management of Acute Phase of Ischaemic Stroke
1.4.3. Secondary Prevention
Anti-Platelet Treatment
Blood-Pressure-Lowering Treatment
Statin Treatment
Anticoagulant Treatment
Carotid Revascularization
2. Preclinical Neurorestorative Studies
2.1. Animal Model
2.1.1. Ischemic Animal Model
Models Requiring Craniotomy
Models Not Requiring Craniotomy
2.1.2. Intracerebral Hemorrhage (IHC) Model
2.2. Neurorestorative Strategies
2.2.1. Medicine and Factors
Heat Shock Protein (Hsp70)
Estrogens
Voltage-Gated Cation Channel Modulators
NMDA Antagonists
Radical Scavengers
Statins
2.2.2. Bioengineering
Gene-Modified Stem Cells
2.2.3. Cell Therapy
Granulocyte-Colony Stimulating Factor (G-CSF)
Embryonic Stem Cells (ESCs)
Induced Pluripotent Stem Cells (iPSCs)
Neural Stem /Progenitor Cells (NSPCs)
Immortalized Cell Lines: NT2 Cell Line
Mesenchymal Stromal Cells (MSCs)
Umbilical Cord Blood Cells (UCBCs) and Related Cells
3. Clinical Neurorestorative Studies
3.1. Scoring System of Assessment for Stroke
3.2. Neurorestorative Strategies
3.2.1. Medicines and Molecules
Radical Scavengers
Calcium Antagonists
NMDA Antagonists
Scavenging Divalent Metal Ions
Minocycline
3.2.2. Cell Therapy
3.2.2.1. Bone Marrow Mononuclear and Stromal cells (BMMNCs and BMSCs)
BMMNCs and BM-BMCs in Acute/Subacute Stage of Stroke
BMMNCs and BMSCs in Chronic Stage Of Stroke
3.2.2.2. Neurons Derived from Teratocarcinoma
3.2.2.3. Umbilcal Cord Stromal Cells
3.2.2.4. Autologous Peripheral Blood Stromal Cells
Other Cell Type
Combination Cell Therapy
3.2.3. Neuromodulation
References
Chapter 80
Innovations in Stroke Rehabilitation: From Research to Clinical Practice
Abstract
1. Introduction
2. Robotic Verticalization
3. Robotic Gait Training
3.a. End-effector Devices
3.b Lokomat
4. Upper Limb Robotic Rehabilitation
4.a. Armeo
5. FES-Cycling and Beyond
6. Vitalstim
7. Computerized Cognitive Rehabilitation
8. Virtual Reality
9. Telerehabilitation
10. CAREN
Conclusion
References
Chapter 81
Digital Subtraction Angiography in Vascular Imaging of Stroke
1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
2Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China
3Department of Medicine, Chongqing Medical University, Chongqing, China
4Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Abstract
Carotid Stenosis
Cerebral Aneurysms
2D versus 3D DSA
3D DSA versus CTA
3D DSA versus MRA
Collateral Circulation
References
Chapter 82
Moyamoya: A Focal ICA Pathology Causing Ischemic and Hemorrhagic Stroke
Abstract
Introduction
Inflammation
Leukocytes
Macrophages
T Cells
Cytokines, Chemokines and Growth Factors
Cytokines
Chemokines and Adhesion Molecules
Growth Factors
Autoimmunity
Autoantibodies
Autoimmune Disorders and Other Predisposing Diseases
Genetics
HLA
Ring Finger Protein 213 (RNF213)
Growth Factors and Cytokines
Treatment
Case Scenarios
Case 1: Hemorrhagic Presentation
Case 2: Ischemic Presentation
Animal Models
Conclusion
References
Chapter 83
The Combined Use of tDCS and Other Rehabilitation Techniques to Improve Upper Limb Motor Function after Stroke
Abstract
Introduction
Combined Therapies for Upper Limb Motor Recovery
tDCS + Constraint Induced Movement Therapy
tDCS + Virtual Reality Therapy
tDCS + Robot Assisted Arm Training
tDCS + Occupational Therapy
Comments
References
Chapter 84
Does Anosognosia Affect the Short-Term Goals Achievement in Medical Rehabilitation for Patients with Acute Ischemic Stroke?
Abstract
Purpose
Methods
Results
Discussion
Conclusion
References
Chapter 85
Video-Based Quantification of Patient’s Compliance during Post-Stroke Virtual Reality Rehabilitation
Abstract
Introduction
Methods
Experimental results
Conclusion
Acknowledgments
References
Chapter 86
Colour-Check in Stroke-Rehabilitation Games
Abstract
Introduction
State of the Art
Methods
Research and Development
Testing and Contribution to the Field
Conclusion and Planned Activities
Acknowledgment
References
Chapter 87
Stroke-Prone Spontaneously Hypertensive Rats: Insights on Neuronal Vulnerability and Astrocytic Abnormalities in Stroke
Abstract
Abbreviations
1. Introduction
2. Neuronal Vulnerability and Redox Regulation in the Brain of SHRSP Rats under Ischemic Conditions
2.1. Vulnerability of Neuronal Cells in SHRSP Rats
2.2. ROS Production and Neuronal Injury
2.3. Redox Regulation in SHRSP Rats
2.4. Preventive Effects of Vitamin E
2.5. Apoptosis and Neuronal Cell Death in SHRSP Rats
3. Characteristics of SHRSP Rat Astrocytes and Correlations with Stroke
3.1. Roles of Astrocytes in Stroke
3.2. GDNF Production in Astrocytes and in SHRSP Rats
3.3. Regulation of L-Serine Production and Neuronal Cell Survival
3.4. Regulation of Inflammation by HMGB1 in SHRSP Astrocytes
3.5. Stimulation of TNF-Α and Expression of Vascular Cell Adhesion Molecule-1 in Astrocytes
Conclusion
Acknowledgments
References
Chapter 88
Pure Motor Monoparesis Due to Ischemic Stroke
Abstract
Introduction
A Brief History of PMM Due to IS
PMM Criteria
Frequency
Lesion Topography and Clinical Features
Cerebral Cortex
Arm
Leg
Subcortex, Centrum Semiovale, and Corona Radiata
Internal Capsule
Brainstem
Mechanisms of Stroke in PMM
Differential Diagnosis
Prognosis
Further Investigation
References
Chapter 89
Stroke Associated with Nephrotic Syndrome - Acute Ischemic Stroke, Cerebral Venous Sinus Thrombosis, and Intracerebral Hemorrhage
Abstract
1. Introduction
2. Screening for Stroke Patients with NS
3. Acute Ischemic Stroke (AIS) Associated with NS
1) AIS Patients
2) Arterial Stenosis in the Patients
4. Cerebral Venous Sinus Thrombosis (CVT) Associated with NS
1) CVT Patients (Table 5)
Case 1
Case 2
2) Literature Review of CVT Patients with NS
5. Intracerebral Hemorrhage (ICH) Associated with NS
1) ICH Patients
Case 1
Case 2
Case 3
Case 4
Discussion
References
Chapter 90
Post-Stroke Dysphagia
Abstract
Introduction
Neural Control of Swallowing
Brainstem and Peripheral Control
Higher Nervous System Control
Lesion Location
Diagnostic Issues
Water Swallow Test (WST)
Bulbar Function Assessment
Pulse Oxymetry and Silent Aspiration
Clinical and Neuroanatomical Predictors of Post-Stroke Dysphagia
Recovery from Post-Stroke Dysphagia and Persistent Dysphagia
References
Chapter 91
Oxytocin as a Treatment Option in Right Hemisphere Stroke
Abstract
Introduction
Overview of Right Hemisphere Stroke
Defining Empathy
Towards a Nuanced Understanding of Oxytocin
Oxytocin and Emotional Empathy in the Brain
Envisioning Oxytocin Treatment for Right Hemisphere Stroke
Considerations for Future Oxytocin Treatment Research
Conclusion
References
Biographical Sketch
Chapter 92
Short-Term Predictors of Mortality among Patients with Hemorrhagic Stroke
Abstract
Introduction
Methodology
Populations and Methods
Procedure of Data Collection
Procedure of Data Analysis
Operational Definitions
Smoking
Smokeless Tobacco (SLT)
Statistical Analysis
Ethical Consideration
Results
Discussion
Conclusion
Limitation
Future Direction
Conflict of Interest
Acknowledgment
Contributions by the Authors
References
Chapter 93
Electrical Stimulation in Stroke Patients
Abstract
Introduction
Upper-Limb
Lower-Limb and Gait
Hemiplegic Shoulder
Dysphagia
Urinary Incontinence
Visuo-Spatial Neglect
Conclusion
References
Biographical Sketch
Chapter 94
Multimodal Monitoring in Decompressive Craniectomy for Traumatic Brain Injury and Stroke
Abstract
Introduction
Intracranial Pressure and Cerebral Perfusion Pressure
ICP Wave Forms
Pressure Volume Compensatory Reserve
Methods of ICP Monitoring
Noninvasive Modalities for ICP Monitoring
Indications for ICP Monitoring
ICP Monitoring in Traumatic Brain Injury and Outcomes
Cerebral Blood Flow, Cerebral Perfusion Pressure, and Ischemia
Cerebral Blood Flow
Cerebral Perfusion Pressure
Cerebral Autoregulation
Pressure Reactivity Index
Brain Oxygenation
SjVO2
PbtO2
ORx
NIRS
Systemic Oxygenation
Cerebral Metabolism and Microdialysis
Electrophysiology
Glucose and Nutrition
Temperature and Inflammation
Acute Stroke and the Role of Multimodal Monitoring
Location of Monitoring
ICP and CPP Monitoring in Stroke
Cerebral Blood Flow in Stroke
Cerebral Microdialysis in Stroke
Monitoring of Cerebral Edema in Stroke
Limitations of Multimodal Monitoring
Conclusion
References
Chapter 95
Decompressive Craniectomy in Ischemic Stroke
Abstract
Introduction
Acute Management of Ischemic Stroke
Studies of Decompressive Craniectomy
DECIMAL [26]
DESTINY [27]
HAMLET [24, 28]
Meta-Analyses
Posterior Circulation Infarctions and Decompression
Quality of Life
Opinions from Experience
Future Directions
Conclusion
References
Chapter 96
Virtual Reality-Augmented Rehabilitation for Patients in Sub-Acute Phase Post-Stroke: A Feasibility Study
Abstract
Introduction
Methods
System
Simulations
Training protocol
Outcome measures
Results
Discussion
References
Chapter 97
A Comparison of Upper Limb Movement Profiles When Reaching to Virtual and Real Targets Using the Oculus Rift: Implications for Virtual-Reality Enhanced Stroke Rehabilitation
Abstract
Introduction
Methods
Procedure
Motion-capture/VR system setup
Quantifying the data
Discussion
Conclusion
References
Chapter 98
Subjective Perceptions When Using Motion Tracking Systems: A Comparison Among Healthy Subjects, Individuals Post-Stroke, and Therapists
Abstract
Introduction
Methods
Brief description of the tracking systems
Virtual environment
Procedure
Statistical analysis
Results
Discussion
Acknowledgments
References
Chapter 99
Evaluating the Microsoft Kinect for Use in Upper Extremity Rehabilitation Following Stroke as a Commercial Off-The-Shelf Gaming System
Abstract
Introduction
Methods
Population
Data collection
Results
Qualitative findings
Discussion
Acknowledgments
References
Chapter 100
Leap Motion Controller and Oculus Rift Virtual Reality Headset for Upper Arm Stroke Rehabilitation
Abstract
Introduction
Our Study
Participant Recruitment
Target Acquiring Exercise (TAGER)
Experimental Setup
Results
Usability
Model Effectiveness
Discussion
References
Chapter 101
Home Based Virtual Rehabilitation for Upper Extremity Functional Recovery Post-Stroke
Abstract
Introduction
System Design
Hardware
Software
System Calibration and Hand Position Correction
Data Collection
System Validation
Car Simulation
Maze Simulation
Questionnaire
System Server for Data Monitoring and Visualization
Discussion
References
Chapter 102
Face to Face: An Interactive Facial Exercise System for Stroke Patients with Facial Weakness
Abstract
Introduction
Patient Benefit
Clinical Need
Initial System Concepts
System Overview
Our Study
Findings
Pose Example
Discussion
Acknowledgments
References
Chapter 103
Stroke Due to Vasculitis in Adults
Abstract
Introduction
Primary CNS Vasculitis
Primary Large Vessel Vasculitis
Primary Medium Vessel Vasculitis
Primary Small Vessel Vasculitis
Anca-Associated Vasculitis
Granulomatosis with Polyangiitis
Microscopic Polyangiiits
Eosinophilic Granulomatosis with Polyangiitis
Immune Complex Vasculitis
Cryoglobulinemic Vasculitis
Hypocomplementemic Urticarial Vasculitis/C1q
References
Chapter 104
Direct and Indirect Benefits of Translingual Neurostimulation Technology for Neurorehabilitation of Chronic Stroke Symptoms
Abstract
1. Introduction
2. Research Design and Context
3. Results
3.1. Direct Benefits of Physical Rehabilitation
3.1.1. Recovery of Balance
3.1.2. Gait Normalization
3.1.3. Mobility Rehabilitation
3.2. Indirect Benefits of Mental Rehabilitation
3.2.1. Recovery of Emotional Control
3.2.1. Speech Rehabilitation
3.3. Participant Self-Reports
3.3.1. Renewed Quality of Life
4. Discussion and Conclusion
5. Acknowledgments
6. Disclosure
References
Chapter 105
Rehabilitation Interventions for Upper Limb Recovery Following Stroke
Abstract
Introduction
Conventional Neurological Treatment
Kinesitherapy
Therapeutic Positioning of the Paretic Arm
Bilateral Arm Training
Biofeedback
Sensory Interventions
Cognitive Sensory Motor Training Therapy
Physical Agents
Emerging Approaches
Technology Supported Training
Conclusion
References
Biographical Sketch
Chapter 106
Cognitive Impairment and Dementia Following Ischemic Stroke and Cardiac Arrest in Humans
Abstract
Introduction
Cardiac Arrest
Ischemic Stroke
Conclusion
References
Chapter 107
Post-Ischemic Dementia with Alzheimer’s Disease Phenotype Following Ischemic Stroke in Humans and Experimental Ischemic Brain Injury
Abstract
Introduction
Dementia Following Ischemic Stroke in Humans
Dementia Following Experimental Ischemic Brain Injury
Conclusion
Acknowledgments
References
Chapter 108
Stroke and Alzheimer’s Disease: Common Mechanisms and Therapeutic Approaches
Abstract
Introduction
Animal Models of Stroke and Alzheimer’s Disease
The Connection between Pathophysiology Mechanisms and Therapeutic Approaches in Stroke and Alzheimer’s Disease
References
Chapter 109
Video-Based Quantification of Patient’s Compliance during Post-Stroke Virtual Reality Rehabilitation
Abstract
Introduction
Methods
Experimental results
Conclusion
Acknowledgments
References
Chapter 110
Colour-Check in Stroke-Rehabilitation Games
Abstract
Introduction
State of the art
Methods
Research and development
Testing and contribution to the field
Conclusion and planned activities
Acknowledgment
References
Chapter 111
Evaluation of Leap Motion Controller and Oculus Rift for Virtual-Reality-Based Upper Limb Stroke Rehabilitation
Abstract
Introduction
Methods
Participant recruitment
Target acquiring exercise (TAGER)
Experimental setup
Results
Usability
Model effectiveness
Discussion
References
Chapter 112
Remote Communication, Examination, and Training in Stroke, Parkinson’s, and COPD Care: Work in Progress Testing 3D Camera and Movement Recognition Technologies Together with New Patient-Centered ICT Services
Abstract
Introduction
Methods
Results
Discussion
Conclusion
Acknowledgments
References
Chapter 113
Radical Approaches to Stroke
Abstract
1. Introduction
2. Pathophysiological Condition Responsible for Progression of Stroke and Cerebral Injury
2.1. Atherosclerosis
2.2. Cardioembolic Stroke
2.3. Reduced Systemic Pressure
2.4. Hematological Disorders
2.5. Small Vessel Disease
2.6. Vasospasm
3. Treatment Strategies for Acute Ischemic Conditions
3.1. Management of Acute Ischemic Stroke
3.1.1. Intravenous Thrombolytics
3.1.2. Combined Pharmacological Approach
3.1.3. Sonothrombolysis
4. Crosstalk between Oxidative Stress and Cellular Injury
4.1. Oxidative Stress Induced by ROS Generation in Myocardial Reperfusion Injury
4.2. Key Mechanisms Responsible for Cellular Injury in Stroke
5. Major Biochemical Changes and Cellular Mechanisms of Cerebral Injury
5.1. Ionic and Metabolic Changes in the Core and Penumbra
5.2. Energy Metabolism in Stroke
5.3. Free Radical Generation in Cerebral Reperfusion Injury
5.3.1. Xanthine/Hypoxanthine Oxidation
5.3.2. Nitric Oxide and Peroxynitrite Generation
5.3.3. Eicosanoid Accumulation in Ischemic Brain Regions
5.3.4. Ischemia-Induced Alteration in Mitochondrial Function
5.3.5. Role of Monoamine Accumulation
5.4. pH Changes during Stroke
5.5. Anoxic Depolarisation and Na+-K+ Pump in Cerebral Reperfusion Injury
5.6. Inflammation in Reperfusion Injury
5.7. Phospholipid Metabolism
5.8. Permeability of Blood-Brain Barrier in Stroke
5.9. Apoptosis
6. Markers of the Ischemia/Reperfusion Injury
6.1. Oxidative Stress/Antioxidant Biomarkers
6.1.1. Superoxide Dismutase
6.1.2. Activity of Catalase
6.1.3. Glutathione Depletion and Role of Glutathione Peroxidases
6.1.4. Lipid Peroxidation as Bio-Indicator
6.2. Creatine Kinase
6.3. Myeloperoxidase
6.4. Measurement of Plasma Fibrinogen
7. Pharmacological Strategies to Protect the Reperfused Tissue
7.1. Neuroprotection in Cerebral Reperfusion Injury
7.2. Antioxidants and the Therapy Based on Antioxidant Markers
7.2.1. Inhibition of Lipid Peroxidation
7.2.2. Inhibition of Xanthine Oxidase
7.2.3. SOD and Advance SOD Mimetics
7.2.4. Catalase and Glutathione Peroxidase Activities
7.2.5. Nitric Oxide Synthase Inhibitor
7.3. Poly (ADP-ribose) Polymerase Inhibitors
7.4. Spin Traps Application
7.5. Glutamate Antagonists
7.6. Inhibition of Interleukins
7.7. Matrix Metalloproteinases Inhibitors
7.8. Heat Shock Proteins
8. Agents with Established Antioxidant Activity in Reperfusion Injury
8.1. Lipoic Acid
8.2. Coenzyme Q10
8.3. Trimetazidine
9. Recent Developments, Future Opportunities and Challenges
Conclusion
References
Index
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