Navigating the Complexities of Stroke

289 Pages·2013·2.61 MB·English

by  Louis R. Caplan

Navigating the
Complexities of Stroke
Lisa M. Shulman, MD
Editor-in-Chief, Neurology Now™ Book Series
Fellow of the American Academy of Neurology
Professor of Neurology
University of Maryland School of Medicine
Baltimore, MD
Other Titles in the Neurology NowTM Book Series
Navigating Life with Parkinson Disease
Sotirios A. Parashos, MD, PhD; Rose Wichmann, PT; and Todd Melby
Navigating Life with a Brain Tumor
Lynne P. Taylor, MD, FAAN; Alyx Porter Umphrey, MD; and Diane Richard
Navigating the
Complexities
of Stroke
Louis R. Caplan , MD
Professor of Neurology
Harvard University
Senior Neurologist
Beth Israel Deaconess Medical Center
Boston, MA

1
3
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© American Academy of Neurology 2013
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Library of Congress Cataloging-in-Publication Data
Caplan, Louis R.
Navigating the complexities of stroke / Louis R. Caplan, MD, professor of neurology,
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
pages cm
Includes bibliographical references and index.
ISBN 978–0–19–994571–9 (alk. paper)
1. Cerebrovascular disease. I. Title.
RC388.5.C3294 2014
616.8′1—dc23 2012043697
Th is material is not intended to be, and should not be considered, a substitute for medical or other professional
advice. Treatment for the conditions described in this material is highly dependent on the individual
circumstances. And, while this material is designed to off er accurate information with respect to the subject
matter covered and to be current as of the time it was written, research and knowledge about medical and health
issues is constantly evolving and dose schedules for medications are being revised continually, with new side
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not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred
as a consequence of the use and/or application of any of the contents of this material.
Disclosure statements for potential confl icts of interest provided by the authors are available
upon request from the American Academy of Neurology, 201 Chicago Avenue, Minneapolis,
MN 55415; Attn: Neurology Now Books.
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Printed in the United States of America
on acid-free paper
CONTENTS
About the AAN’s Neurology Now TM Book Series | ix
Lisa M. Shulman, MD
Foreword | xiii
Preface | xv
1. Introduction: Why Is Stroke So Important? | 1
Eff ect of Strokes on Individuals | 1
Th e Complexity of Stroke | 2
Numbers | 4
Strokes in History | 6
Th e Plan of Th is Stroke Primer | 7
2. What Does the Brain Look Like and How Does It Work? | 9
Th e Appearance of the Brain | 10
Brain Functions | 18
3. How Does the Body Bring Blood to the Brain?
Th e Anatomy of the Heart and Brain-Supplying
Blood Vessels | 37
Th e Heart | 38
Th e Aorta and Its Main Brain-Supplying Branches | 39
Arteries within the Neck | 41
Arteries within the Skull | 42
Veins | 46
v
vi CONTENTS
4. What Is a Stroke? What Are the Diff erent Kinds
of Stroke? | 48
What Is a Stroke? | 48
What Are the Diff erent Types of Strokes? | 49
5. What Are the Medical Conditions Th at Cause Strokes? | 60
Blood Vessels | 60
Blood Vessel Abnormalities Th at Cause Brain Ischemia and
Infarction | 62
Conditions Th at Cause Brain and Subarachnoid Hemorrhage | 73
6. Strokes and Cerebrovascular Conditions in the Young | 79
Newborns and Infants | 79
Children and Adolescents | 81
Young Adults (20–40 Years) | 84
7. What Are the Diff erent Symptoms of Stroke?
What Abnormalities Do Doctors Look for and Find in
Stroke Patients? | 87
Symptoms Due to Loss of Brain Function | 90
Sleepiness, Lethargy, Stupor, and Coma | 95
Summing up the Symptoms to Locate the Part of the Brain
Involved | 96
Symptoms Th at Relate to Stroke Cause | 96
What Findings Do Doctors Look for in Patients Suspected of
Having a Stroke? | 97
8. What Are the Risk Factors for Stroke and
How Can Th ey Be Reduced? | 1 01
Transient Ischemic Attacks | 101
Early Knowledge of Risk Factors Is the Key to Prevention | 103
Medical Risk Factors | 106
Behavior and Lifestyle | 118
Contents vii
9. How Can Doctors Tell What Caused the Stroke? What Tests
Are Used to Evaluate Individuals Who May Have Had a
Stroke? | 124
History of the Events and Symptoms | 124
Th e Physical Examination | 126
Radiology and Other Laboratory Testing | 127
Brain Imaging | 127
Making Images of the Blood Vessels and Determining
Blood Flow | 130
Heart Tests | 141
Studying the Electrical Activity of the Brain | 142
Blood Tests | 143
10. What Treatments Are Available to Treat Acute
Stroke Patients? | 147
Acute Brain Ischemia | 147
Treating Acute Hemorrhage Within or Around the Brain | 155
Preventing Another Stroke | 155
11. Complications | 158
Neurologic Complications | 158
Medical Complications | 161
Depression and Other Psychological Reactions | 166
12. What Are Some of the Dysfunctions, Disabilities, and
Handicaps Th at Remain after a Stroke? | 167
Motor Abnormalities | 167
Sensory Abnormalities | 169
Cognitive and Behavioral Abnormalities | 171
Visual Abnormalities | 179
Urinary, Bowel, and Sexual Dysfunctions | 181
viii CONTENTS
13. How Does Recovery from Stroke Occur? How Can Recovery
Be Improved? What Is Rehabilitation? Where Is It
Performed and by Whom? | 184
Recovery | 184
Rehabilitation Hospitals and Wards | 189
Outpatient Th erapy | 193
Rehabilitation and Exercising Can Be Overdone|194
14. How Does One Person’s Stroke Aff ect Others? | 196
15. What Does the Future Hold? | 203
16. Case Summaries | 2 11
17. Planning for Your Future: Managing Your
Personal Aff airs | 218
Murray Sagsveen, JD, and Laurie Hanson, JD
Your Emergency Notebook | 219
Informal and Formal Arrangements | 221
Durable Power of Attorney | 226
Trusts | 229
Health Care Directives | 235
Guardianship and Conservatorship | 240
Your Will | 241
suggested reading | 
glossary | 
about the aan and the abf | 
index | 
ABOUT THE AAN’S N EUROLOGY NOW ™
BOOK SERIES
Here is a question for you:
If you know more about your neurologic condition, will you do better than
if you know less?
Well, not simply optimism but hard data show that individuals who
are more knowledgeable about their medical conditions do have bet-
ter outcomes . So learning about your neurologic condition plays an
important role in doing the very best you can. Th e main purpose
of both the American Academy of Neurology’s (AAN’s) Neurology
Now TM book series and Neurology Now magazine is to focus on the
needs of people with neurologic disorders. Our goal is to view neu-
rologic issues through the eyes of people with neurologic problems,
in order to understand and respond to their practical day-to-day
needs.
So, you are probably saying, “ Of course, knowledge is a good thing,
but how can it change the course of my disease?” Well, health care is
really a two-way street. You need to fi nd a knowledgeable and trusted
neurologist; however, no physician can overcome the obstacle of
working with inaccurate or incomplete information. Your physician
is working to navigate the clues you provide in your own words com-
bined with the clues from their neurologic examination, in order to
ix