Cerebrovascular Disease (What Do I Do Now) by Ji Y. Chong

By Ji Y. Chong

Sufferers struggling with cerebrovascular ailment pose many medical demanding situations or even skilled clinicians can arrive on the element the place diagnostic, work-up, remedy, or prognostic considering falters.

Authored by way of a vascular neurologist whose paintings spans the complete spectrum of this crew of mind dysfunctions, Cerebrovascular Disease is helping clinicians evaluation and deal with sufferers being affected by stroke, embolism, thrombosis, hemorrhage, and different severe shows. In a clinical box the place it really is usually tough to distill the immense array of analysis and observe it in any significant medical method, this subsequent quantity within the "What Do I Do Now?" sequence makes a speciality of jogging the clinician via evidence-based decision-making. each one scientific state of affairs featured in Cerebrovascular Disease describes in cautious element the presentation, diagnostic experiences, healing procedures, and motive for dealing with those tough cases.

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Wright JT, Dunn JK, Cutler JA, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA 2005;293:1595–​1608. 10. Small Vessel Disease 47 48 49 11 Obstructed Flow A 68-​year-​old woman with a history of tobacco abuse presented with left-​sided weakness and dysarthria. She had been having some difficulty walking at home but did not seek medical attention. Her family noted a facial droop and brought her to the ER. She was noted to have a left homonymous hemianopia, left facial droop, mild left arm and leg weakness, and some sensory neglect of the left side.

JAMA 2014;311(5):507–​520. Lawes CM, Bennett DA, Feigin VL, et al. Blood pressure and stroke: An overview of published reviews. Stroke 2004;35:776–​785. Meschia JF, Bushnell C, Boden-​Albala B, et al. Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/​ American Stroke Association. Stroke 2014;45:3754–​3832. O’Donnel MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): A case–​control study.

44 WHAT DO I DO NOW? Cerebrovascular Disease 45 comorbidities, current guideline recommendations advise a target pressure <140/​ 90 in patients who have had a stroke. However, recent evidence from the SPS3 trial suggests that there may be some benefit from more strict blood pressure control (less than systolic 130 mmHg) in patients with lacunar stroke. SPS3 showed a strong trend toward reduction in the primary outcome of all stroke as well as significantly less intracerebral hemorrhage in those treated with more aggressive blood pressure control.

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