Seminars in Cerebrovascular Diseases and Stroke最新文献

Cerebral venous thrombosis (CVT) is characterized by an extreme variability in its clinical presentation and mode of onset. The combination of magnetic resonance imaging and magnetic resonance venography is currently the best method for diagnosis of CVT. It can also be done by computed tomography venography. Catheter angiography is only rarely necessary. Numerous causes have been described, and an extensive work-up is required. The prognosis, although better than previously thought, remains unpredictable, and should be initiated emergently in all cases. It is based on the combination of the treatment of the etiology, symptomatic treatment of seizures and intracranial hypertension, and antithrombotics. Heparin remains the first-line antithrombotic treatment for CVT. Recent studies have confirmed its safety even in patients with hemorrhagic parenchymal lesions. Local thrombolysis or mechanical thrombectomy are indicated in the rare cases of deterioration despite adequate anticoagulation.

Coronary artery bypass surgery is a common surgical procedure. The objective of this article is to discuss the cerebrovascular complications of this surgery. Coronary artery bypass surgery can cause brain injury, typically from emboli or brain hypoperfusion. Ischemic strokes do occur after coronary artery bypass surgery. Techniques have been developed to lessen the chance of brain infarction, including performing the surgery without the use of a cardiopulmonary bypass machine. Neuropsychologic decline can also occur after surgery and is discussed. The clinical presentations of brain infarcts are discussed as well as the evaluation and treatment of these patients.

Stroke is a significant complication following cardiac valve surgery. The risk of stroke is governed by a number of variables including location of the valve (mitral versus aortic), adequacy of anticoagulation, presence of atrial fibrillation, and patient comorbidities. Interestingly, the risk of thromboembolism appears equal regardless of whether the prosthesis is a mechanical or bioprosthetic valve.

This article examines the incidence, mechanisms, recognition, prevention, and management of strokes associated with congenital heart disease in infants and children.

Today, over 1 million coronary interventions are performed in the United States. Cerebrovascular complications during interventional cardiology procedures are rare; however, they can have devastating consequences. This review will address cerebrovascular complications during percutaneous coronary intervention (PCI) with either stenting or balloon angioplasty in the era of powerful anticoagulation therapy. Also, we will seek to address neurological complications following valvuloplasty.

Ischemic strokes in the brain and the spinal cord are dreaded complications of aortic arch surgery. The etiology of these strokes is most typically embolic from atheromatous material but compression or dissection of branch vessels or hypoperfusion (particularly of radicular spinal branches) may be associated with increased stroke risk. Various techniques including partial left heart bypass with hypothermic circulatory arrest and retrograde or anterograde cerebral perfusion along with lumbar cerebrospinal fluid drainage may decrease the risk of neurovascular complications of aortic arch or thoracic aortic surgery. The risks of neurovascular complications with endovascular stenting of the aorta are unclear at this time.

Chronic heart failure syndrome is reaching a significant magnitude. Due to limitations in the available treatment options, mechanical circulatory assist devices are assuming a bigger role in the management of this difficult group of patients. Cerebrovascular events certainly appear to complicate the course of treatment using this evolving technology. Some of the events are due to patient-related factors, but some are related to the device and its interaction with the living organism. Differences in the incidence of these complications among the available devices provide the hope that better understanding of the causes followed by design modifications will lessen the occurrence of cerebrovascular events with this form of therapy.