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Stroke Practical Management Stroke Practical Management THIRD EDITION C. Warlow J. van Gijn M. Dennis J. Wardlaw J. Bamford G. Hankey P. Sandercock G. Rinkel P. Langhorne C. Sudlow P. Rothwell Stroke Practical Management THIRD EDITION Dedication To our many colleagues, young and old, with whom we have shared the care of so many stroke patients, and with whom we have discussed so many interesting ideas. Acknowledgement The authors of this book are particularly grateful to Joanna Warldlaw, who has drawn much of the line artwork throughout the three editions. Stroke Practical Management THIRD EDITION C. Warlow J. van Gijn M. Dennis J. Wardlaw J. Bamford G. Hankey P. Sandercock G. Rinkel P. Langhorne C. Sudlow P. Rothwell © 2007 C. Warlow, J. van Gijn, M. Dennis, J. Wardlaw, J. Bamford, G. Hankey, P. Sandercock, G. Rinkel, P. Langhorne, C. Sudlow, P. Rothwell Published by Blackwell Publishing Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First edition published 1996 Second edition published 2001 Third edition published 2008 1 2008 Library of Congress Cataloging-in-Publication Data Stroke : practical management / C. Warlow . [et al.]. – 3rd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4051-2766-0 (hardcover : alk. paper) 1. Cerebrovascular disease. 2. Cerebrovascular disease – Treatment. I. Warlow, Charles, 1934- [DNLM: 1. Cerebrovascular Accident – therapy. 2. Intracranial Hemorrhages – therapy. 3. Ischemic Attack, Transient – therapy. WL 355 S9208 2007] RC388.5.S847 2007 616.8’1 – dc22 2007022955 ISBN: 978-1-4051-2766-0 A catalogue record for this title is available from the British Library Set in 9/12pt Stone Serif by Graphicraft Limited, Hong Kong Printed and bound in Singapore by Fabulous Printers Pte Ltd Commissioning Editor: Martin Sugden Editorial Assistant: Jennifer Seward Development Editor: Lauren Brindley Production Controller: Debbie Wyer For further information on Blackwell Publishing, visit our website: http://www.blackwellpublishing.com The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The Publisher is not associated with any product or vendor mentioned in this book. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Contents Contributors, vi Acknowledgements, vii Abbreviations, viii 1 Introduction, 1 2 Development of knowledge about cerebrovascular disease, 7 3 Is it a vascular event and where is the lesion?, 35 4 Which arterial territory is involved?, 131 5 What pathological type of stroke is it, cerebral ischaemic or haemorrhage?, 181 6 What caused this transient or persisting ischaemic event?, 259 7 Unusual causes of ischaemic stroke and transient ischaemic attack, 353 8 What caused this intracerebral haemorrhage?, 411 9 What caused this subarachnoid haemorrhage?, 457 10 A practical approach to the management of stroke and transient ischaemic attack patients, 503 11 What are this person’s problems? A problem-based approach to the general management of stroke, 537 12 Specific treatments for acute ischaemic stroke, 635 13 Specific treatment of intracerebral haemorrhage, 703 14 Specific treatment of aneurismal subarachnoid haemorrhage, 719 15 Specific interventions to prevent intracranial haemorrhage, 767 16 Preventing recurrent stroke and other serious vascular events, 789 17 The organization of stroke services, 903 18 Reducing the impact of stroke and improving the public health, 953 Index, 980 Colour plates are found facing p.550 v Contributors Charles Warlow University of Edinburgh, Western General Hospital, Edinburgh, UK Jan van Gijn Utrecht University, Utrecht, the Netherlands Martin Dennis University of Edinburgh, Western General Hospital, Edinburgh, UK Joanna Wardlaw University of Edinburgh, Western General Hospital, Edinburgh, UK John Bamford St James’ University Hospital, Leeds, West Yorkshire, UK Graeme Hankey Royal Perth Hospital, Stroke Unit, Perth WA, Australia Peter Sandercock University of Edinburgh, Western General Hospital, Edinburgh, UK Gabriel Rinkel Utrecht University, Utrecht, the Netherlands Peter Langhorne Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, UK Cathie Sudlow University of Edinburgh, Western General Hospital, Edinburgh, UK Peter Rothwell Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK vi Acknowledgements We have had invaluable help and advice from many Also, thank you to our teachers and colleagues from people in the preparation of this third edition. So thank whom we have learned so many worthwhile things over you all, including: the years: Sheena Borthwick Henry Barnett Judi Clarke Lou Caplan Carl Counsell David Chadwick Ann Deary Iain Chalmers Alice Emmott Rory Collins Hazel Fraser Hans van Crevel Paut Greebe Richard Doll Gord Gubitz Geoff Donnan Ingrid Kane Stuart Douglas Sarah Keir Shah Ebrahim Alistair Lammie Rob Edis Lynn Legg Barbara Farrell Richard Lindley C. Miller Fisher Mike McDowell Chris Foote Michael Mackie John Fry Ian Marshall Mike Gent Nick Morgan Sonny Gubbay Ross Naylor Michael Harrison Sarah Pendlebury Jim Heron David Perry Steff Lewis Rustam Al-Shahi Salman Bryan Matthews Cameron Sellers Richard Peto Mark Smith Alex Pollock Ian Starkey Geoffrey Rose Stuart Taylor David Sackett Brenda Thomas Robin Sellar Theo vanVroonhoven David Shepherd Nic Weir Jim Slattery Rien Vermeulen Ted Stewart-Wynne Derick Wade Eelco Wijdicks vii Abbreviations We don’t care much for abbreviations. They are not liter- ATP Adenosine triphosphate ate (Oliver Twist was not abbreviated to OT each time ATT Antithrombotic Trialists’ Collaboration Dickens mentioned his name!), they don’t look good on AVF Arteriovenous fistula the printed page, and they make things more difficult to AVM Arteriovenous malformation read and understand, particularly for non-experts. But BA Basilar artery they do save space and so we have to use them a bit. BIH Benign intracranial hypertension However, we will avoid them as far as we can in tables, BMI Body mass index figures and the practice points. We will try to define any BP Blood pressure abbreviations the first time they are used in each chap- C Celsius ter, or even in each section if they are not very familiar. CAA Cerebral amyloid angiopathy But, if we fail to be comprehensible, then here is a rather CADASIL Cerebral autosomal dominant arteriopathy long list to refer to. with subcortical infarcts and leukoencephalopathy ACA Anterior cerebral artery CAST Chinese Acute Stroke Trial ACE Angiotensin converting enzyme CAVATAS Carotid and Vertebral Artery Transluminal AChA Anterior choroidal artery Angioplasty Study ACoA Anterior communicating artery CBF Cerebral blood flow ACST Asymptomatic Carotid Surgery Trial CBFV Cerebral blood flow velocity ADC Apparent diffusion coefficient CBV Cerebral blood volume ADH Antidiuretic hormone CCA Common carotid artery
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