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Neurosonology and Neuroimaging of Stroke 2nd Edition PDF

Neurosonology and Neuroimaging of Stroke 2nd Edition PDF : A Comprehensive Reference

Neurosonology and Neuroimaging of Stroke 2nd Edition PDF
Author José Manuel Valdueza
File size 141 MB
Year 2016
Pages 768
Language English
File format PDF
Category Neurology
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Book Description
Stroke is one of the most commonly occurring brain diseases and, in spite of its often homogeneous clinical appearance, its causes vary considerably. The implemen-tation of a tailored and targeted therapy in each indi-vidual case requires rapid etiological classification and a qualified evaluation of the vascular status. Knowledge of normal vascular anatomy, variants, and anomalies are essential for proper clinical assessment In the 1970s, conventional angiography was practical-ly the only method capable of visualizing brain-supply-ing arteries. In the 1980s, magnetic resonance imaging (MRI) and computed tomography (C7) were developed and gradually implemented into clinical practice. Since the end of the 1990s, the latter methods have evolved into sophisticated angiologic techniques. However, despite being well established, they do have limitations: MRI re-quires patient compliance and may not be used in patients with a pacemaker. CT involves radiation exposure and a angiography (CTA) requires the administration of a con-trast agent An excellent alternative diagnostic modality to study the brain-supplying arteries is diagnostic ultra-sound. The technique is in fact a powerful, noninvasive, inexpensive, and dynamic tool which not only captures a snapshot of vessels, but shows real hemodynamics over time Ultrasound can be used quickly and spontaneous-ly. It follows rules and pathways but defies full stan-dardization, thereby allowing space for individualized decision-making on a case-by-case basis. The sonographer has the advantage of being directly at the patient’s side and is therefore capable of speaking with the patient, winning their confidence, and diminishing their anxiety. It is the doctor and not the machine guiding the probe and it is the clinical question that motivates the investigation. In clinical neurology, ultrasound became available in the early 1970s. The neurovascular focus developed in the 1980s with the use of extracranial color-coded du-plex sonography (ECCS) and transcranial Doppler (TCD) techniques. The development of transcranial color-coded duplex sonography (TCCS) in the early 1990s was an important advance, as TCCS’s diagnostic sensitivity ex-ceeded that of TCD. B-mode and color-mode images gen-erated using TCCS greatly facilitated vessel identification by offering additional spatial information about vessel courses in relation to bone, parenchymal structures, and ventricles. In the mid-1990s, we shifted our routine vascular diagnostic procedures away from TCD to TCCS. The combination of extra- and intracranial duplex ultra-sound permits an almost comprehensive assessment of all brain-supplying vessels with a single bedside device. TCD remains the primary method for functional assess-ments such as right-left shunt diagnosis, assessment of
cerebrovascular reactivity, autoregulation, and bilateral continuous monitoring for spontaneous microemboli. What is the best diagnostic approach for patients with acute and chronic brain ischemia? Several angiologic methods are now available for the treatment of stroke patients: DSA, MRA, CTA, and ultrasound. Each technique may yield information that is partly competing and part-ly complementary regarding vessel anatomy, vessel wall properties, and circulation physiology. Stroke physicians should be aware of the strengths and weaknesses of each of the available methods. In this book, we point out both the advantages and limitations of each of these methods, but the reader should also consider availability and in-vestigator skill. The concept of this book is based on the combined teaching experience gained by the authors (J.M.Valdueza, Si. Schreiber, J.-E. Roehl, and F. Connolly) in ultrasound courses, seminars, and lectures over the past 15 years. We realized that the presentation and discussion of real cases provoked the greatest interest among our listeners, which we have again considered by adding new and instructive clinical case reports. The book is divided into two parts. Part A outlines the necessary basic principles, with a particular focus on the precise description of ultrasound anatomy and the relat-ed examination techniques. The online materials accom-panying this book include video sequences of a complete extra- and intracranial arterial and venous duplex ex-amination and of fusion imaging with MRL Part A also includes a discussion of the basic principles of cerebral hemodynamics and a comprehensive presentation of pathologic findings in ectracnnial and intracranial ste-noses and occlusions. The relevant stroke aspects from a clinical and radiologic point of view are presented in a separate chapter. Part A ends with an overview of the cur-rently available neuroradiologic techniques—DSA, MRA, and CTA (R. Klingebiel). In Part B, we present 45 case histories of selected pa-tients managed either in the Department of Neurology, Chaska’ – Universititsmedizin Berlin (Germany), or in the Neurological Center in Bad Segeberg (Germany). Each case is divided into two sections: the case report and a discussion. In the case reports, the diagnostic algorithm and the therapeutic strategy are presented in chronolog-ic order. Each case report begins with a short history of the presenting complaint and a description of the initial radiologic findings. On these grounds, we have formulat-ed a hypothesis and angiologic questions to be answered using ultrasound. The findings of extra- and intracranial color-coded duplex sonography are controlled for plau-sibility and the postulated hypothesis is confirmed or…
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