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Stroke Medicine Published and Forthcoming Oxford Specialist Handbooks OXFORD MEDICAL PUBLICATIONS Stroke Medicine Published and forthcoming Oxford Specialist Handbooks General Oxford Specialist Handbooks Oxford Specialist Handbooks A Resuscitation Room Guide in Neurology Addiction Medicine, 2e Epilepsy Day Case Surgery Parkinson’s Disease and Other Movement Perioperative Medicine, 2e Disorders, 2e Pharmaceutical Medicine Stroke Medicine, 2e Postoperative Complications, 2e Renal Transplantation Oxford Specialist Handbooks in Oncology Oxford Specialist Handbooks Practical Management of Complex in Accident & Emergency Medicine Cancer Pain Retrieval Medicine Oxford Specialist Handbooks Oxford Specialist Handbooks in Paediatrics in Anaesthesia Paediatric Dermatology Anaesthesia for Medical and Surgical Paediatric Endocrinology and Diabetes Emergencies Paediatric Gastroenterology, Hepatology, Cardiac Anaesthesia and Nutrition Neuroanaesthesia Paediatric Haematology and Oncology Obstetric Anaesthesia Paediatric Intensive Care Ophthalmic Anaesthesia Paediatric Nephrology, 2e Paediatric Anaesthesia Paediatric Neurology, 2e Regional Anaesthesia, Stimulation Paediatric Radiology and Ultrasound Techniques Paediatric Respiratory Medicine Thoracic Anaesthesia Paediatric Rheumatology Oxford Specialist Handbooks Oxford Specialist Handbooks in Cardiology in Pain Medicine Adult Congenital Heart Disease Spinal Interventions in Pain Management Cardiac Catheterization and Coronary Intervention Oxford Specialist Handbooks Cardiac Electrophysiology and Catheter in Psychiatry Ablation Child and Adolescent Psychiatry Cardiovascular Computed Tomography Forensic Psychiatry Cardiovascular Magnetic Resonance Medical Psychotherapy Echocardiography, 2e Old Age Psychiatry Fetal Cardiology Heart Failure, 2e Oxford Specialist Handbooks Hypertension in Radiology Inherited Cardiac Disease Interventional Radiology Nuclear Cardiology Musculoskeletal Imaging Pacemakers and ICDs Pulmonary Imaging Pulmonary Hypertension Thoracic Imaging Valvular Heart Disease Oxford Specialist Handbooks Oxford Specialist Handbooks in Surgery in Critical Care Cardiothoracic Surgery, 2e Advanced Respiratory Critical Care Colorectal Surgery Cardiothoracic Critical Care Gastric and Oesophageal Surgery Hand Surgery Oxford Specialist Handbooks Hepatopancreatobiliary Surgery in End of Life Care Neurosurgery End of Life Care in Cardiology Operative Surgery, 2e End of Life Care in Dementia Oral and Maxillofacial Surgery, 2e End of Life Care in Nephrology Otolaryngology and Head and Neck Surgery End of Life Care in Respiratory Disease Paediatric Surgery End of Life in the Intensive Care Unit Plastic and Reconstructive Surgery Surgical Oncology Oxford Specialist Handbooks Urological Surgery in Infectious Disease Vascular Surgery, 2e Infectious Disease Epidemiology Oxford Specialist Handbooks in Neurology Stroke Medicine Second Edition Hugh Markus Professor of Stroke Medicine University of Cambridge, and Honorary Consultant Neurologist Addenbrooke’s Hospital, Cambridge, UK Anthony Pereira Consultant Neurologist Department of Neurology St George’s Hospital, London, UK Geoffrey Cloud Consultant Stroke Physician Department of Neurology St George’s Hospital, London, UK 1 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2017 The moral rights of the authors have been asserted First Edition published in 2010 Second Edition published in 2017 Impression: 1 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, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2015960466 ISBN 978– 0– 19– 873788– 9 Printed in Great Britain by Ashford Colour Press Ltd, Gosport, Hampshire Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast- feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. v Preface to the Second Edition There have been major advances in the management of stroke since the last edition in 2010. These culminated in a series of trials, led by the MR CLEAN trial, showing that patients who had occlusion of the large cerebral vessels had a better outcome if treated with thrombectomy compared with intra- venous thrombolysis. The last 5 years have also provided more data show- ing how organization of stroke care can have a major impact on outcome. For example, centralizing care within London into eight hyperacute stroke units with direct ambulance transfer to these units resulted in an approxi- mately 30% reduction in mortality. These are exciting times for stroke. In this Second Edition we have completely revised and updated the text to take into account these and many other advances. The First Edition received excellent feedback and we are grateful for all the helpful comments we received. We are grateful to Hannah Cock for contributing to the section on post-stroke epilepsy in this edition. Hugh Markus Anthony Pereira Geoffrey Cloud vi Preface to the First Edition Recent years have seen a revolution in the profile of stroke. Often thought of as an untreatable disease we now realize that, not only can many strokes be prevented, but acute treatment can have a major impact on outcome. Organized care within stroke units markedly reduces mortality. Thrombolysis is transforming the way in which acute stroke services are organized. It is encouraging both the medical profession and the general public to think of stroke as a potentially treatable “brain attack” requir- ing urgent diagnosis, transfer to hospital, and treatment. Recent data has shown that minor stroke and TIA is followed by a high risk of early recur- rent stroke, much higher than previously appreciated. Preventing this early recurrence prevents major challenges in how we reconfigure services, and determine which early secondary prevention strategies are most effective. These advances in stroke present many challenges in delivering services. In many countries stroke has been a ‘Cinderella’ specialty and there have been few senior doctors specifically trained in stroke care. Specialists from geriatric medicine, neurology, and other disciplines are having to train them- selves in hyperacute stroke management, and familiarize themselves with the many other advances in management which are required to deliver comprehensive stroke care. We will need many more stroke specialists in the future and this has led to the establishment of dedicated stroke train- ing programmes, such as the UK Stroke Specialty training programme, and similar schemes in other countries. Clinicians looking after stroke patients need rapid access to up to date practical information on how to look after stroke patients. We hope this text book of stroke medicine will provide such a source. It is written by two neurologists and a stroke physician, who together run a busy district and regional stroke service. It is aimed to provide a ready source of information for both stroke trainees and consultants. It is written to cover the syllabus of the UK stroke specialist training programme and other similar programmes worldwide. Hugh Markus Anthony Pereira Geoffrey Cloud vii Contents Symbols and abbreviations ix 1 Epidemiology and stroke risk factors 1 2 Neuroanatomy 47 3 Vascular anatomy and stroke syndromes 65 4 History- taking in the stroke patient 97 5 Examination of the stroke patient 109 6 Investigation of the stroke patient 143 7 Imaging in stroke 151 8 Ischaemic stroke: common causes 203 9 Acute stroke treatment 227 10 Secondary prevention of stroke 281 11 Unusual causes of stroke and their treatment 329 12 Cerebral venous thrombosis 373 13 Cerebral haemorrhage 389 14 Recovery and rehabilitation 437 15 Vascular dementia 493 16 Organization of stroke services 515 17 Ethical issues in stroke care 527 Appendix 1 Glossary 543 Appendix 2 Useful stroke scales 557 Appendix 3 Useful websites 579 Index 583 ix Symbols and abbreviations ACA anterior cerebral artery ADC apparent diffusion coefficient
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