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Index

ACA see anterior cerebral artery (ACA)aciclovir, 159, 198activated recombinant coagulation factor VII, 42acute cerebellar stroke, symptoms, 84acute disseminated encephalomyelitis (ADEM),

treatment, 197–8acute embolic infarction

in middle cerebral artery territory, 155–7clinical history, 155examination, 155follow-up, 155–6studies, 155

acute encephalitis, 197–8acute hemorrhage, of pons, due to cavernous

malformation, 171–3acute inferolateral thalamic lesions, 20acute ischemia, 61acute ischemic distal arm paresis, 130–2

clinical history, 130etiology, 131–2examination, 130follow-up, 130lesions, 131studies, 130

acute ischemic Foix-Chavany-Marie syndrome,121, 123–5

clinical history, 123examination, 123follow-up, 124studies, 123–4

acute ischemic lesions, 32, 79, 235acute lacunar lesions, 15, 16acute pontine infarction, 174acute stroke

and brain edema, 245diagnosis, 1–2diffusion-weighted imaging/perfusion-weighted

imaging mismatchclinical history, 255images, 256, 257examination, 255follow-up, 256spontaneous resolution, 255–8studies, 255–6

etiology, 1–2in posterior cerebral artery territory,

27–9, 233

clinical history, 27examination, 27follow-up, 27–9studies, 27

symptoms, visual, 28–9treatment, issues, 257–8see also bihemispheric acute stroke

ADEM (acute disseminatedencephalomyelitis), 197–8

alien limb syndromeearly studies, 108etiology, 108posterior subtype, and bilateral hemispheric

stroke, 106–9subtypes, 108–9transient, 108use of term, 108

Alzheimer’s disease, and microangiopathiclesions, 241

amaurosis fugaxsymptoms, 28–9see also transient monocular blindness

American Heart Association, Guidelines, 164amyloid angiopathy, 159see also cerebral amyloid angiopathy (CAA)

Ancient Egypt, intracranial aneurysmstudies, 57–8

aneurysmsatrial septum, 28cerebral, 250etiology, 225–6follow-up, long-term, 226giant, 225–6mesenterial artery, 247–8ruptured, and subarachnoid

hemorrhage, 56–9saccular, 56, 252–3see also basilar artery aneurysm growth;

carotid aneurysms; intracranial aneurysmsangioectatic retroauricular neurofibroma, 247angiography, 151

cerebral, 111–12indications, 5–7intra-arterial, 219and subarachnoid hemorrhage, 7see also magnetic resonance

angiography (MRA)

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angioplasty, 222anoxia, 187–8anterior cerebral artery (ACA), 25

hypoperfusion, 72occlusion, 72ruptured aneurysm, 56and subarachnoid hemorrhage, 56–9

tissue destruction, 148anterior cerebral artery stroke, 72

CT studies, 73early studies, 73with mutism, hemiparesis and

hemineglect, 71–4clinical history, 71CT studies, 73examination, 71follow-up, 71–2studies, 71

anterior internal optic artery territory see polarartery territory

antibiotics, 166, 169antibodies, 178–80

anticardiolipin, 181antiphospholipid, 180

anticoagulants, 102, 169, 222in Sneddon syndrome treatment, 179vs. antiplatelet agents, 93

anticoagulation, 226antiepileptics, 102antiphospholipid syndrome, 102

differential diagnosis, 181treatment, 180

antiplatelet agents, vs. anticoagulants, 93Anton’s syndrome, 28aphasia, 59, 198, 214, 255

discrete, 256global, 193

apoplexia, 1arm ischemia, recurrent, 213arrhythmias, 2–3

ventricular, 9arterial dissection, and stroke, 95arterial gas embolism, 187–8arterial hypertension, 56

and intracerebral hemorrhages, 39–40,41, 237

arteriosclerosis, 86arteriovenous malformations (AVMs),

227–9clinical history, 227–9examination, 227follow-up, 227hemorrhage risk, 229images, 228and seizures, 229studies, 227treatment, 229

arteritisgiant cell, 217see also Takayasu arteritis

arthralgia, 186ASDs see atrial septal defects (ASDs)

Asians, asymptomatic occlusions, 222aspirin, 16, 44, 98–9, 102–3, 182–3, 255

platelet aggregation inhibition, 106–7secondary prophylaxis, 27–9, 35, 68secondary stroke prevention, 179

ataxia, 224gait, 68

ataxic hemiparesis, 17atheromas, 3atherosclerosis

and basilar artery occlusions, 176, 225–6and multiple brain infarcts, 233

atherosclerotic middle cerebral artery stenosisincidence, 92multiple cerebral infarctions in, 90–3stroke mechanisms, 92

atrial fibrillation, 31, 255and brain embolism, 33and innominate artery occlusion, 210–13

atrial septal defects (ASDs), 94diagnosis, 95diagnostic issues, 96incidence, 95–6treatment, 95, 96

atrial septum, aneurysms, 28aura, 139

and cortical spreading depression, 194–5migraine with, 193, 194–5

automatic voluntary dissociation, 123, 125AVMs see arteriovenous malformations (AVMs)azathioprine, 201

Babinski’s reflex, 23basal ganglia, lesions, 151, 152basilar artery, dilated curved, 208basilar artery aneurysm growth, 224–6

clinical history, 224examination, 224images, 225mechanisms, 226studies, 224

basilar artery occlusions, 176, 225–6clinical history, 174diagnostic criteria, 176early studies, 176etiology, 176examination, 174follow-up, 174–5images, 175long-term risks, 176prognosis, 176studies, 174

bihemispheric acute strokedue to bilateral carotid artery stenosis, 230–4clinical history, 230etiology, 233examination, 230follow-up, 231images, 232studies, 230–1

bihemispheric ischemic lesions,etiology, 233–4

260 Index






bilateral anterior operculum syndromesee Foix-Chavany-Marie syndrome (FCMS)

bilateral brain stem infarction, 121and locked-in syndrome, 120–2

bilateral carotid artery stenosisand bihemispheric acute stroke, 230–4treatment, 233trigger factors, 233

bilateral hemispheric strokewith posterior subtype alien limb

syndrome, 106–9clinical history, 106diagnostic issues, 109diagnosis, 108examination, 106studies, 106–7

bilateral internal carotid artery dissection, 80mimicking inflammatory demyelinating

disease, 79–81clinical history, 79diagnosis, 81examination, 79follow-up, 79–80incidence, 81studies, 79

bilateral simultaneous middle cerebral arteryinfarctions

simultaneous, 113via paradoxical embolism, 111–14clinical history, 111diagnosis, 113, 114examination, 111studies, 111–12

bilateral vertebral artery dissections, 182–5clinical history, 182examination, 182follow-up, 182–3and stroke, 184–5studies, 182

Binswanger disease, 240see also subcortical vascular encephalopathy

(SVE), with acute DWI lesion and suddenclinical deterioration

bisoprolol, 230Blackhall, John, 57–8bladder carcinomas, 75blood tests, 2borderzone infarction, 92

use of term, 36–7bradyarrhythmia, 31brain

arterial circulation, 175see also multiple brain infarcts

brain attacks, 3, 10cardiovascular investigations, 9

brain edema, and acute stroke, 245brain embolism

clinical history, 133diagnostic issues, 135etiology, 33examination, 133fatal, and undiagnosed cardiac tumor, 133–5

follow-up, 133–4multiple brain infarcts, 134studies, 133

brain ischemia, recurrent, 213brain perfusion, studies, 222branch territory cerebellar infarcts,

etiology, 69–70bruits, left orbital, 252bupivacaine, 75–6bypass surgery, extra-intracranial, 222

CAA see cerebral amyloid angiopathy (CAA)CADASIL see cerebral autodominant

arteriopathy with subcortical infarctsand leukoencephalopathy (CADASIL)

cafe au lait spots, 249calcium, 227capsular warning syndrome (CWS), symptoms,

99–100carcinomas, of bladder, 75cardiac tumors

diagnostic issues, 135incidence, 134treatment, 134–5undiagnosed, and brain embolism, 133–5see also myxomas

cardioembolic stroke, 10multiple brain infarcts in, 31–3

cardioembolism, 233and basilar artery occlusions, 176and ischemic strokes, 33and multiple brain infarcts, 233and stroke, 95

cardiovascular investigations,importance of, 9

carotid aneurysmsimages, 248, 249and Recklinghausen’s disease, 247–50clinical history, 247examination, 247follow-up, 247–8studies, 247

surgical resection, 247–8carotid artery dissection

differential diagnosis, 152–3see also internal carotid artery dissections

(ICADs)carotid artery stenosis

hemodynamic stroke in, 35–8see also bilateral carotid artery stenosis

carotid cavernous fistulae (CCF)classification, 253–4etiology, 254images, 253spontaneous occlusionclinical history, 252examination, 252follow-up, 252–3studies, 252via intracavernous aneurysm of internalcarotid artery, 252–4

treatment, 254

261 Index






carotid endarterectomy, and perioperativestroke, 148–9

cauda equina, lesions, 76–7cavernomas, 171–3

characteristics, 172clinical history, 171examination, 171follow-up, 171localization, 172prevalence, 172removal, 171risk factors, 172studies, 171treatment, 173

cavernous angiomas see cavernomascavernous malformations

and acute hemorrhage of pons, 171–3cerebral, 172

cavernous sinus thrombophlebitis(CST), 166–9

clinical history, 166diagnostic criteria, 169etiology, 169examination, 166follow-up, 167images, 168incidence, 169mortality rates, 169studies, 166–7treatment, 169

CBS (cystathionine beta synthetase), 104CCA (common carotid artery), 146CCMs (cerebral cavernous malformations), 172CCT see cranial computed tomography (CCT)ceftriaxone, 167cefuroxime, 166central nervous system (CNS), isolated

angiitis, 197–201cerebellar infarction, 174

disease course, 164–5management, 164pseudotumoral, 162–5studies, 164–5symptoms, 164

cerebellar strokespace occupying, 162–5clinical history, 162examination, 162follow-up, 162–3images, 163, 164studies, 162

cerebellar vermishemodynamic infarction in, 83, 84and vertebral dissection, 82–5

cerebral amyloid angiopathy (CAA)characteristics, 160diagnostic criteria, 160incidence, 160and reversible leukoencephalopathy, 158–61clinical history, 158examination, 158follow-up, 159

studies, 158–9, 160–1and white matter changes, 160–1

cerebral aneurysms, and neurofibromatosistype I, 250

cerebral autodominant arteriopathy withsubcortical infarcts and leukoencephalopathy(CADASIL), 137–9

clinical history, 137diagnosis, 139differential diagnosis, 139etiology, 139examination, 137markers, 139studies, 137symptoms, 139white matter lesions, 138

cerebral cavernous malformations (CCMs),localization, 172

cerebral infarcts, studies, 92cerebral ischemia, 193, 231

and alien limb syndrome, 108etiology, 37–8, 81symptoms, 152–3

cerebral vasculitis, 197–201clinical history, 197examination, 197follow-up, 198studies, 197–8see also isolated angiitis of central

nervous systemcerebral venous thrombosis, 10–11, 47–50

clinical history, 47diagnostic issues, 117–18etiology, 50non-infectious, 49

examination, 47follow-up, 47in homocystinuria, 102–4clinical history, 102diagnostic issues, 104examination, 102follow-up, 102–3studies, 102treatment, 104

non-infectious settings, 50studies, 47treatment, 50use of term, 117see also subarachnoid hemorrhage (SAH)

cerebral white matter lesionsclinical history, 186and diving, 186–8examination, 186studies, 186

cerebrospinal fluid (CSF)analysis, 10–11, 137, 158–9, 166–7pleocytosis, 197–8

Champion, R. H., 180chemosis, 166, 254chest x-rays, 2Chlamydia pneumoniae (bacteria), 231cholecalciferol, 227

262 Index






cholecystitis, 141cholecystolithiasis, 141chronic bronchitis, 230chronic microangiopathy, and subcortical vascular

encephalopathy, 241clopidogrel, 23–4, 91, 130, 219collateralization

leptomeningeal, 222Moyamoya type, 249–50and stroke risk, 148–9

common carotid artery (CCA), occlusion, 146computed tomography (CT), 244

hematoma studies, 39indications, 3infarction studies, 111–12, 162non-contrast, 56, 235non-contrast cranial, 227subarachnoid hemorrhage studies, 116thrombosis studies, 166–7see also cranial computed tomography (CCT)

consumptive coagulopathy, 166–7contralateral hemiplegia, 73–4cortical biopsies, 159cortical infarcts, 92cortical lesions, 36cortical spreading depression, and aura, 194–5corticosteroids, 198cranial computed tomography (CCT), 86, 255

hemorrhage studies, 127infarction studies, 133, 141

creatine kinase, levels, 214–15CST see cavernous sinus thrombophlebitis (CST)CT see computed tomography (CT)CWS (capsular warning syndrome), 99–100cyclophosphamide, 198, 201cystathionine beta synthetase (CBS),

mutations, 104cystic lesions, 24cytomegalovirus, and isolated angiitis of central

nervous system, 201cytotoxic edema, 190

decompression sickness (DCS), 186and patent foramen ovale, 188pathogenesis, 188and scuba diving, 187–8

deep vein thrombosis (DVT), 94, 112incidence, 96

DemTect test, 137diamox, 167diffusion-weighted imaging (DWI), 90, 155,

182–3, 257acute infarction studies, 151acute inferolateral thalamic lesions, 19acute ischemic lesion studies, 130, 155cerebral infarct studies, 67–8, 92hyperintense lesion studies, 106–7lesions, and subcortical vascular

encephalopathy, 239–42transient global amnesia studies, 191

diffusion-weighted imaging/perfusion-weightedimaging (DWI/PWI) mismatch, 37–8

advantages, 258concept of, 257spontaneous resolution, in acute stroke, 255–8

digoxin, 255dilatative arteriopathy

and stroke, 208–9use of term, 209see also dolichoectatic basilar artery

diplopia, 254dissection

arterial, 95see also carotid artery dissection; vertebral

artery dissections; vertebral dissectiondiving

and cerebral white matter lesions, 186–8see also decompression sickness (DCS)

dizziness, 86, 193, 197, 224see also vertigo

dolichoectasia, use of term, 208dolichoectatic basilar artery, 208–9

clinical history, 207diagnosis, 208examination, 207studies, 207see also dilatative arteriopathy

Donnan syndrome (capsular warningsyndrome), 99–100

Doppler sonographyextracranial, 151see also transcranial Doppler

sonography (TCD)dural fistulas, 254dural sinus thrombosis, and stroke, 48–9DVT see deep vein thrombosis (DVT)DWI see diffusion-weighted imaging (DWI)DWI/PWI mismatch see diffusion-weighted

imaging/perfusion-weighted imaging(DWI/PWI) mismatch

dysarthria, 86, 90, 98, 120, 162, 182–3, 224dysarthria clumsy hand syndrome

due to lacunar stroke, 15–17clinical history, 15examination, 15follow-up, 16studies, 15–16

dysphagia, 120

ECG see electrocardiography (ECG)echocardiography

indications, 3transesophageal, 3, 141, 186, 231, 255–6transthoracic, 31, 90, 197–8

edema, 53brain, 245cytotoxic, 190periorbital, 166vasogenic, 235

EEG see electroencephalography (EEG)Ehlers-Danlos syndrome, 254Ehrmann, S., 180electrocardiography (ECG), 2, 86, 155

indications, 9

263 Index






electroencephalography (EEG), 116, 158, 162indications, 2–3, 9

electronystagmography, 82–3, 252–3, 254embolic infarction

etiology, 237and long-haul flights, 94–6clinical history, 94diagnosis, 95, 96examination, 94follow-up, 94studies, 94, 96see also acute embolic infarction

embolic ischemic lesions, 214–15embolic stroke

via right atrial primary cardiaclymphoma, 86–8

clinical history, 86etiology, 88examination, 86follow-up, 86–7incidence, 88studies, 86see also recurrent embolic stroke

embolismarterial gas, 187–8and branch territory cerebellar infarcts, 69–70and hypoperfusion, 92–3and infarction, 109and innominate artery occlusion, 210–13and multiple brain infarcts, 233see also brain embolism; cardioembolism;

paradoxical embolism; pulmonaryembolism (PE)

embolization, arteriovenous malformationtreatment, 229

encephalitisacute, 197–8herpes simplex, 159meningoencephalitis, 166–7

encephalopathies, 201epileptic seizures, 102Escherichia coli (bacteria), 231, 233–4estrogen substitution, and Sneddon

syndrome, 181evoked potentials (EP) recordings, indications, 9exanthema, 186exophthalmia, 254extracranial vessels, spontaneous dissection, 81eye movements, 120–1eyelid movements, 120–1

facial nerve, transient lesions, andperimesencephalic subarachnoidhemorrhage, 127–9

FCMS see Foix-Chavany-Marie syndrome (FCMS)fibrinogen levels, 242FLAIR images see fluid-attenuated inversion

recovery (FLAIR) imagesflights, long-haul, and embolic infarction, 94–6fluid-attenuated inversion recovery (FLAIR)

images, 19, 158–9, 178–9focal sensory seizures, 167

Foix-Chavany-Marie syndrome (FCMS)diagnostic issues, 125etiology, 125symptoms, 125see also acute ischemic Foix-Chavany-Marie

syndromefrontal lobe syndrome, and polar artery territory

infarction, 206fundoscopy, 39

gait ataxia, 68ganglionic hemorrhages, 53gastric ulcers, 189giant cell arteritis, differential diagnosis, 217Glasgow Coma Scale, 2, 111, 127, 133, 166glibenclamide, 255Goldmann perimetry, 27Goldstein, Kurt, 108granulomatous angiitis see isolated angiitis of

central nervous system

Handel, George Frederickstroke, 1–1recovery, 11

headaches, 56, 162, 166, 197, 201, 224bilateral occipital, 227–9etiology, 152–3holocephalic, 127right-side, 235and Sneddon syndrome, 178, 180and subarachnoid hemorrhage, 58see also migraine

Helicobacter pylori (bacteria), 189hematocrit levels, 242hematoma evacuation

indications, 41–2surgical issues, 41

hematomas, 53, 226intracerebral, 235mural, 182, 183, 184

hemicraniectomypostoperative images, 245and space-occupying middle cerebral artery

stroke, 244–6trials, 246

hemineglect, and anterior cerebral arterystroke, 71–4

hemiparesis, 59, 86–7, 146and anterior cerebral artery stroke, 71–4ataxic, 17left-sided, 90, 102, 151, 219pure motor, 17right-sided, 99, 120, 162, 182–3, 198, 224, 244sensorimotor, 235

hemiplegia, 52contralateral, 73–4

hemisensory syndrome, 21hemodynamic infarction, in centre of cerebellar

vermis, and vertebral dissection, 82–5hemodynamic lesions

etiology, 37occurrence, 36–7

264 Index






hemodynamic risk zones, 36, 37hemodynamic stress, and aneurysms, 225–6hemodynamic stroke

in carotid artery stenosis, 35–8clinical history, 35examination, 35follow-up, 35studies, 35

hemorrhagesacute, 171–3cerebral, 1–2ganglionic, 53intracranial, 10–11parenchymal, 10–11space-occupying, 40typical, 237see also hypertensive hemorrhages; intracerebral

hemorrhages (ICHs); intraparenchymalhemorrhage; spontaneous hypertensive basalganglionic intracerebral hemorrhage;subarachnoid hemorrhage (SAH)

heparin, 120, 142, 174, 182–3in cerebral venous thrombosis treatment, 50

herpes simplex encephalitis, 159herpes simplex virus, 198Heubner, Johann Otto Leonhard, 73Hodgkin’s disease, 201Hollenhorst plaques, 29homocysteine blood levels, 102–3, 104homocysteine metabolism, 103homocystinuria, 102–3

and cerebral venous thrombosis, 102–4homonymous hemianopia, 27, 28–9, 210

diagnosis, 27Horner’s syndrome, 44, 60, 62

differential diagnosis, 152–3Hunt and Hess classification, 58, 59hydrocephalus

obstructive, 39occlusive, 224

hydrochlorothiazide, 16hypercholesterolemia, 158, 178hyperhomocysteinemia, 102

prevalence, 104and vascular disease, 104

hyperlipoproteinemia, 230hypermethionemia, 102–3hypertension, 1–25, 203, 207, 225–6, 230, 255see also arterial hypertension

hypertensive hemorrhageslocalization, 41pathogenesis, 39–40, 41

hypoperfusion, 72, 92, 233and embolism, 92–3and migraine with aura, 195pathomechanisms, 160

hypovolemia, 246

ICA see internal carotid artery (ICA)ICADs see internal carotid artery dissections

(ICADs)ICHs see intracerebral hemorrhages (ICHs)

immunosuppressants, 217impeding paradoxical embolism (IPE), 114incomplete ischemia

clinical features, 146diagnosis, 148diagnostic issues, 148–9examination, 146follow-up, 147MR features, 146–9studies, 146

infarctionacute pontine, 174cerebral, 92cortical, 92and embolism, 109hemispheric, 246hemodynamic, 82–5myocardial, 2–3polar artery territory, 203–6posterior choroidal, 21postoperative, 148–9right sensory cortex/subcortex, 108territorial, 24–5thalamic, 21, 204vertebral, 77see also bilateral brain stem infarction; bilateral

simultaneous middle cerebral arteryinfarctions; borderzone infarction; cerebellarinfarction; embolic infarction; isolatedcerebellar infarctions; left inferolateralthalamic infarction; multiple brain infarcts;multiple cerebral infarctions; paramedianthalamic infarct; spinal cord infarction

inferolateral strokes, 21inflammatory demyelinating disease, bilateral

internal carotid artery dissectionmimicking, 79–81

infrarenal aorta, aneurysms, 247–8innominate artery occlusion

from embolism, 210–13clinical history, 210diagnostic criteria, 212etiology, 212examination, 210incidence, 212studies, 210–11

and Takayasu arteritis, 213internal carotid artery dissections

(ICADs), 44–6etiology, 45–6spontaneous, 45see also bilateral internal carotid artery

dissection; right internal carotid arterydissection

internal carotid artery (ICA)atherosclerotic narrowing, 37–8intracavernous aneurysms, and spontaneous

occlusion of carotid cavernousfistulae, 252–4

occlusions, 23, 133, 244occlusive disease, 37stenosis, 25, 37–8, 90, 108, 146

265 Index






internal carotid artery (ICA) (cont.)bilateral proximal, 230–1

traumatic aneurysmearly studies, 153and recurrent embolic stroke, 151–3risk factors, 153

International Cooperative Aneurysm Study, 59intracerebral hemorrhages (ICHs)

diagnostic issues, 41etiology, 39–40, 41, 53–4, 237under anticoagulant therapy with perifocal

edema, 52–5clinical history, 52disease progress, 54etiology, 53–4examination, 52follow-up, 52mechanisms, 54risk factors, 53–4studies, 52treatment, 54–5

intracranial aneurysmsearly studies, 57–8ruptured, 57–8

intracranial hemorrhages, 10–11intracranial stenosis, treatment, 93intraparenchymal hemorrhage, 117

and isolated cortical vein thrombosis, 116–18ischemia

acute, 61arm, 213brain, 213left hemispheric, 255ocular, 254posterior circulation, 183see also cerebral ischemia; incomplete ischemia

ischemic strokesetiology, 33and vascular congestion, 237

isolated angiitis of central nervous system,197–201

brain biopsy, 200comorbidity, 201diagnostic criteria, 201symptoms, 201treatment, 198, 201use of term, 201

isolated cerebellar infarctionsclinical history, 67follow-up, 68outcomes, and supratentorial white matter

lesions, 67–70prognosis, 69–70studies, 67–8symptoms, 70

isolated cortical vein thrombosiswith subarachnoid and intraparenchymal

hemorrhage, 116–18clinical history, 116examination, 116follow-up, 116–17studies, 116

Jacksonian march, 116Japanese, asymptomatic occlusions, 222Jenkins, Dr, 1

la main etrangere see alien limb syndromelaboratory tests, 10–11lacunar ischemic lesions, prognosis, 1–2lacunar lesions, 15lacunar stroke

and dysarthria clumsy hand syndrome, 15–17prognosis, 17

lacunar syndromes, 17lacunes

etiology, 16issues, 16–17studies, 16–17use of term, 16

lamotrigine, 167laparoscopy

and middle cerebral artery stroke, 141–4procedures, 141risk factors, 144

lateral medullary syndrome, 60–3clinical history, 60diagnostic issues, 62–3etiology, 62examination, 60follow-up, 60studies, 60symptoms, 62treatment, 62see also Wallenberg’s syndrome

Lausanne Stroke Registry, 32–3, 73left hemispheric ischemia, 255left inferolateral thalamic infarction

due to microangiopathy, 19–21clinical history, 19examination, 19follow-up, 19–20studies, 19

left occipital lobe, infarcts, 211leptomeningeal biopsies, 159leptomeningeal collateralization, 222lesions

acute inferolateral thalamic, 20acute ischemic, 32, 79, 235acute lacunar, 15, 16bihemispheric ischemic, 233–4cortical, 36cystic, 24embolic ischemic, 214–15grading, 229hyperintense, 60, 106–7, 199lacunar, 15lacunar ischemic, 1–2microangiopathic, 241partial hand knob, 132periventricular, 72punctuate, 15subcortical, 36see also hemodynamic lesions;

white matter lesions (WMLs)

266 Index






leukoaraiosis see subcortical vascularencephalopathy (SVE)

leukocytosis, 19, 166–7leukoencephalopathy

and cerebral amyloid angiopathy, 158–61etiology, 160lobar, 160–1periventricular, 160–1see also cerebral autodominant arteriopathy

with subcortical infarcts andleukoencephalopathy (CADASIL)

Lisch nodules, 249livedo racemosa, 178–80livedo reticularis, 180locked-in syndrome

diagnostic criteria, 122etiology, 121, 122symptoms, 122use of term, 122via bilateral brain stem infarction, 120–2clinical history, 120follow-up, 120–1studies, 120

lumbar puncture, indications, 10–11lumbar spine, 76lymphocytosis, 75–6lymphohistiocytic perivascular

dermatitis, 178–80

magnetic resonance angiography (MRA), 120,141, 146, 257

hematoma studies, 44occlusion studies, 155stenosis studies, 219–20vs. angiography, 5–7

magnetic resonance imaging (MRI), 162,174, 208

acute lesion studies, 15, 71, 151advantages, 3–5basilar artery studies, 224carotid aneurysm studies, 247–8cavernoma studies, 171cranial, 90, 137, 214–15fluid-attenuated inversion recovery images,

158–9, 178–9hyperintense lesion studies, 60infarction studies, 94, 99, 146, 210–11, 219–20ischemia studies, 120migraine studies, 193, 195perfusion, 230–1serial, 189–90stroke protocol, 123–4subarachnoid hemorrhage studies, 116T2-weighted, 79, 227, 235, 239thrombosis studies, 102see also diffusion-weighted imaging (DWI);

perfusion-weighted imaging (PWI)magnetic resonance venography, 48, 116, 142mannitol, 167, 246Massachusetts General Hospital (MGH), 212matrix metalloproteinases (MMPs),

activation, 233–4

MCA see middle cerebral artery (MCA)MCA stroke see middle cerebral artery

(MCA) strokeMCA territory see middle cerebral artery

(MCA) territoryMCA/PCA (middle cerebral artery/posterior

cerebral artery) borderzone, infarction,107, 108

meningoencephalitis, 166–7mesenterial artery, aneurysms, 247–8metformin, 16methotrexate, 217methylene-tetrahydrofolate-reductase (MTHFR),

mutations, 102, 104methylprednisolone, 197–8microangiopathic lesions, occurrence, 241microangiopathy

chronic, 241and left inferolateral thalamic infarction, 19–21

middle cerebral artery (MCA)asymmetric perfusion, 194atherosclerotic, 92occlusions, 133, 141, 219–20asymptomatic, 222prognosis, 222

stenosis, asymptomatic, 222middle cerebral artery (MCA) stroke

from paradoxical embolism afterlaparoscopy, 141–4

clinical history, 141etiology, 144examination, 141follow-up, 142studies, 141see also space-occupying middle cerebral

artery stroke; territorial middle cerebralartery stroke

middle cerebral artery (MCA) territoryacute cortical ischemic lesions, 147acute embolic infarction, 155–7acute ischemic lesions, 179hypodensity, 244infarction, 86, 94, 95, 142, 147, 210–11subcortical, 143territorial, 24

paradoxical embolism, 111–14stroke lesions, 123–4T2-hyperintense lesions, 24, 90tissue destruction, 148

middle cerebral artery/posterior cerebral artery(MCA/PCA) borderzone, infarction,107, 108

migraine, 139with aura, 193, 197etiology, 194–5and hypoperfusion, 195pathophysiology, 194–5

with patent foramen ovale, 193–5clinical history, 193examination, 193studies, 193

Mini-Mental State Examination, 239

267 Index






miosis, 60mitral diastolic murmur, 210mitral stenosis, and innominate artery

occlusion, 210–13MMPs (matrix metalloproteinases), 233–4monoxidine, 255motor system, cortical domains, 72motor-sensory hemideficits, right-sided, 193MRA see magnetic resonance angiography (MRA)MRI see magnetic resonance imaging (MRI)MTHFR (methylene-tetrahydrofolate-reductase),

102, 104multiple brain infarcts

brain embolism, 134in cardioembolic stroke, 31–3clinical history, 31examination, 31follow-up, 31studies, 31

and embolism, 233etiology, 32–3, 233studies, 32–3

multiple cerebral infarctions, 91, 92in atherosclerotic middle cerebral artery

stenosis, 90–3clinical history, 90examination, 90follow-up, 91prognosis, 93studies, 90treatment, 93

multiple sclerosis, 197mural hematomas, 182, 183, 184mutism, and anterior cerebral artery

stroke, 71–4myocardial infarction, and stroke, 2–3myxomas, 86

atrial, 88diagnostic issues, 135incidence, 134removal, 134–5and stroke, 134–5

National Institutes of Health,Consensus Panel, 249

National Institutes of Health Stroke Scale(NIHSS), 2, 155, 162–3

nausea, 162, 182, 193, 207, 227–9neurofibromas

angioectatic retroauricular, 247peripheral, 249

neurofibromatosis type Iand cerebral aneurysms, 250diagnosis, 250early studies, 249incidence, 249and stroke, 249–50and subarachnoid hemorrhage, 250symptoms, 249

neurophilic pleocytosis, 166–7neuropsychological testing, 137nicotine abuse, and Sneddon syndrome, 181

NIDDM (non-insulin-dependent diabetesmellitus), 255

NIHSS (National Institutes of Health StrokeScale), 2, 155, 162–3

non-insulin-dependent diabetes mellitus(NIDDM), 255

NOTCH3 gene, mutations, 139nystagmus

horizontal, 207optokinetic, 27, 82–3spontaneous, 182

ocular ischemia, 254oculomotor disturbances, 254ophthalmoscopy, transient monocular blindness

studies, 29optokinetic nystagmus, 27, 82–3osmotherapy, 246osteoporosis, 102–3, 227

palsy, left abducens, 252paradoxical embolism

in both MCA with thrombolysis but fataloutcome, 111–14

etiology, 144and middle cerebral artery stroke, 141–4

paramedian thalamic infarct, 21right anterior, 203, 207

paraphasias, 255paraplegia, 76–7

postoperative, 77–8parenchymal hemorrhages, 10–11paresis

sensorimotor, 214see also acute ischemic distal arm paresis;

hemiparesispartial hand knob lesions, 132patent foramen ovale (PFO), 3, 28, 113, 141, 191

and cerebral white matter lesions, 186–8and decompression sickness, 188and migraine, 193–5prevalence, 144and pulmonary embolism, 113–14, 124and stroke, 144

PCA see posterior cerebral artery (PCA)PCA territory see posterior cerebral artery (PCA)

territoryPE see pulmonary embolism (PE)penicillin, 166, 167perfusion

brain, 222see also diffusion-weighted imaging/

perfusion-weighted imaging (DWI/PWI)mismatch; hypoperfusion

perfusion-weighted imaging (PWI), 90, 155, 257see also diffusion-weighted imaging/

perfusion-weighted imaging (DWI/PWI)mismatch

pericallosal artery, 72, 73perimesencephalic subarachnoid hemorrhage

(pSAH), 128diagnostic issues, 129

268 Index






etiology, 129with transient lesion of facial nerve, 127–9clinical history, 127examination, 127follow-up, 127studies, 127

perioperative stroke, and carotidendarterectomy, 148–9

periorbital edema, 166PFO see patent foramen ovale (PFO)phenprocoumon, 47, 142physiotherapy, and stroke recovery, 11PICA see posterior inferior cerebellar

artery (PICA)platelet inhibitors, 222pleocytosis, 197–8polar artery territory

infarction, 203–6, 205clinical history, 203examination, 203and frontal lobe syndrome, 206images, 204–5studies, 203symptoms, 205–6

polar strokes, 21pons, acute hemorrhage due to cavernous

malformation, 171–3pontine warning syndrome, 98–100, 99

clinical history, 98etiology, 100examination, 98–9studies, 99treatment, 100

posterior cerebral artery (PCA), 21, 227bilateral stenosis, 235disease, 237

posterior cerebral artery (PCA) territoryacute ischemic lesions, 235acute stroke in, 27–9, 233infarction, 210–11

posterior choroidal infarct, 21posterior circulation ischemia, etiology, 183posterior fossa, aneurysms, 21posterior inferior cerebellar artery (PICA), 60

cerebellar infarcts, 162, 212infarcts, 62, 67–8, 69, 210–11, 240occlusion, 62

postoperative infarctions, mechanisms, 148–9primary angiitis of central nervous system

see isolated angiitis of centralnervous system

primary cardiac lymphomas, 86, 87and embolic stroke, 86–8incidence, 88prognosis, 88treatment, 88

primary motor hand function, MRI studies, 131progressive intracranial arterial obstruction of

unknown etiology, 219–22clinical history, 219follow-up, 220images, 220, 221

studies, 219–20treatment, 222

propafenon, 255proptosis, 166pruritus, 186pSAH see perimesencephalic subarachnoid

hemorrhage (pSAH)pseudoaneurysms, 151ptosis, 60, 207, 254pulmonary embolism (PE), 113

and patent foramen ovale, 113–14, 124punctuate lesions, 15pure motor hemiparesis, 17pure sensory stroke, 17PWI see perfusion-weighted imaging (PWI)PWI/DWI mismatch see diffusion-weighted

imaging/perfusion-weighted imaging(DWI/PWI) mismatch

pyridoxine, 102–3, 104

Quincke, Heinrich Irenaeus, 57–8

radiotherapy, arteriovenous malformationtreatment, 229

ramipril, 230Recklinghausen, Friedrich von, 249Recklinghausen’s disease

and carotid aneurysms, 247–50early studies, 249and stroke, 249–50vascular complications, 250see also neurofibromatosis type I

recombinant tissue plasminogen activator(rt-PA), 258

recurrent embolic strokefrom traumatic aneurysm of internal carotid

artery and right subclavian artery, 151–3clinical history, 151examination, 151follow-up, 151studies, 151

rheumatic fever, 210right atrial tumors, 86right cerebral hemisphere, infarcts, 211right internal carotid artery dissection

after cycling, 44–6clinical history, 44examination, 44follow-up, 44studies, 44

right sensory cortex/subcortex infarction, 108right subclavian artery, and recurrent embolic

stroke, 151–3risedronate, 227Rook, A., 180rt-PA (recombinant tissue plasminogen

activator), 258

SAH see subarachnoid hemorrhage (SAH)SCA (superior cerebellar artery), 162scleral injection, 254scotoma, 254

269 Index






scuba divingand cerebral white matter lesions, 186–8risks, 187–8

secondary hemorrhagic transformationsdiagnosis, 237of thalamic strokes, 235–7

seizuresand arteriovenous malformation, 229classification, 229epileptic, 102focal sensory, 167risk factors, 229simple partial sensory, 116tonic-clonic, 227–9treatment, 227

sensorimotor paresis, 214septic thrombosis of cavernous sinuses

see cavernous sinus thrombophlebitis (CST)sexual activity, and stroke, 144simple partial sensory seizures, 116simvastatin, 230Smith, Christopher, 1Sneddon, Ian Bruce, 180Sneddon syndrome (SNS), 178–81

clinical history, 178comorbidity, 180diagnostic criteria, 179–80differential diagnosis, 181early studies, 180etiology, 180examination, 178follow-up, 179images, 179stroke pathogenesis, 180studies, 178–9treatment, 179, 180triggers, 181

sonography see ultrasoundspace-occupying middle cerebral artery stroke

clinical history, 244disease course, 244examination, 244follow-up, 244–5studies, 244and subsequent hemicraniectomy, 244–6surgical issues, 246treatment, 244

spatial disorientation, 84–5speech

abnormalities, 214, 227–9decreased volume, 205–6diminished, 241slurred, 15, 86, 174therapy, 62

Spetzler-Martin scale, 229spinal cord infarction, 76

after surgery in hyperlordotic position, 75–8clinical history, 75diagnostic issues, 76–7etiology, 77examination, 75studies, 75–6

surgical issues, 77diagnosis, 78

spontaneous hypertensive basal ganglionicintracerebral hemorrhage, 39–42

clinical history, 39examination, 39follow-up, 39–40, 41future perspectives, 42studies, 39

spontaneous nystagmus, 182Staphylococcus aureus (bacteria), 169Staphylococcus aureus sepsis, 166–7

treatment, 167stenosis, 174, 219–20

intracranial, 93mitral, 210–13see also atherosclerotic middle cerebral artery

stenosis; carotid artery stenosisstenting, 222, 233steroids, 217

corticosteroids, 198stroke

acute cerebellar, 84biomarkers, 10–11and dilatative arteriopathy, 208–9etiology, 95, 237dural sinus thrombosis, 48–9

in hemodynamic risk zones, 37inferolateral, 21and myocardial infarction, 2–3and myxomas, 134–5overview, 1perioperative, 148–9polar, 21pure sensory, 17and Recklinghausen’s disease, 249–50recovery, 11mechanisms, 2physiotherapy, 11

recurrent embolic, 151–3and sexual activity, 144symptoms, 2, 69–70temporal profiles, 2tests, 2–9and transient ischemic attacks, 3tuberothalamic, 21and vertebral artery dissections, 184–5see also acute stroke; anterior cerebral artery

stroke; bilateral hemispheric stroke;cardioembolic stroke; cerebellar stroke;embolic stroke; hemodynamic stroke;ischemic strokes; lacunar stroke; middlecerebral artery (MCA) stroke;thalamic strokes

stroke risk, and collateralization, 148–9subarachnoid hemorrhage (SAH), 10–11

angiography, 7classification, 58, 59diagnosis, 58–9due to ruptured aneurysm of anterior cerebral

artery, 56–9clinical history, 56

270 Index






examination, 56follow-up, 56images, 57studies, 56

early studies, 57–8and headaches, 58and isolated cortical vein thrombosis, 116–18and neurofibromatosis type I, 250symptoms, 57–9, 118see also perimesencephalic subarachnoid

hemorrhage (pSAH)subcortical hyperintensities, 159, 160subcortical ischemic vascular disease, 17subcortical lesions, 36subcortical vascular encephalopathy (SVE), 1–27,

69–70, 160with acute DWI lesion and sudden clinical

deterioration, 239–42clinical history, 239diagnosis, 240differential diagnosis, 242examination, 239follow-up, 239–40management, 242studies, 239

comorbidity, 241differential diagnosis, 241functional tests, 241symptoms, 241

suboccipital craniectomy, 162, 164sulfamethoxazole, 166superior cerebellar artery (SCA), cerebellar

infarcts, 162superior sagittal sinus, thrombosis, 47, 102, 103superoxide dismutase, 10–11supplementary motor area

disturbances, 73–4localization, 73

supratentorial white matter lesions, and isolatedcerebellar infarctions, 67–70

surgical decompression, 244, 246surgical resection

arteriovenous malformation treatment, 229carotid aneurysms, 247–8

SVE see subcortical vascular encephalopathy (SVE)syphilis, 180systemic lupus erythematosus, 181

Takayasu arteritis, 214–18classification, 216–17clinical history, 214diagnosis, 218differential diagnosis, 217disease progress, 217early studies, 216–17examination, 214images, 215, 216and innominate artery occlusion, 213studies, 214–15symptoms, 216–17, 218treatment, 217

TCD see transcranial Doppler sonography (TCD)

territorial infarction, use of term, 24–5territorial middle cerebral artery stroke, 23–5

clinical history, 23examination, 23follow-up, 23–4studies, 23surgical issues, 25

tetraparesis, 174TGA see transient global amnesia (TGA)thalamic infarction, 21, 204see also left inferolateral thalamic infarction;

paramedian thalamic infarctthalamic pain syndrome, 21thalamic strokes, 21

secondary hemorrhagic transformationof, 235–7

clinical history, 235examination, 235images, 236studies, 235

thalamusarterial supplies, 204–5hematomas, 235vascular lesions, 21vascular territories, 20

thrombendarterectomy, 231, 233thrombocytopenia, 181thrombolysis, 250

effectiveness, 156time factors, 156–7

indications, 258intravenous, 247MRI-guided, 155–7advantages, 157trials, 157

thrombolytics, 257–8thrombosis

dural sinus, 48–9material, 48venous, 96see also cerebral venous thrombosis; deep vein

thrombosis (DVT); isolated cortical veinthrombosis

thrombus, 86TIAs see transient ischemic attacks (TIAs)tinnitus, 162, 207, 252

and right internal carotid artery dissection, 44tonic-clonic seizures, 227–9tracheostomy, 167transcranial Doppler sonography (TCD), 186, 219,

227, 230–1, 235arterial flow studies, 23dolichoectatic basilar artery studies, 209indications, 3stenosis studies, 120

transcranial magnetic stimulation, 197–8transesophageal echocardiography, 3, 186, 231,

255–6transient global amnesia (TGA)

clinical history, 189etiology, 191examination, 189

271 Index






transient global amnesia (TGA) (cont.)follow-up, 190studies, 189–90triggers, 191and upper gastrointestinal endoscopy,

189–91transient ischemic attacks (TIAs), 98–9,

139, 174capsular warning syndrome, 99–100repeated, 99–100, 109and stroke, 3

transient monocular blindnessophthalmoscopy, 29see also amaurosis fugax

transthoracic echocardiography, 31, 90, 197–8traumatic plaque-rupture, etiology, 45–6triamterene, 16trimethoprim, 166tuberothalamic artery territory see polar artery

territorytuberothalamic strokes, 21tumors

benign, 88malignant, 88right atrial, 86subcutaneous, 247see also cardiac tumors

ulcers, gastric, 189ultrasound, 224

advantages, 8–9arterial flow studies, 27carotid aneurysm studies, 247–8compression, 94Doppler duplex, 252, 254duplex, 31, 174, 214–15occlusion studies, 23, 133stenosis studies, 35transcranial, 178–9vs. angiography, 5–7see also Doppler sonography; transcranial

Doppler sonography (TCD)upper gastrointestinal endoscopy

procedure, 189and transient global amnesia, 189–91

urinary tract infection, 231, 233–4

valproate, 159, 227Valsalva maneuver, 28, 141, 186, 191vancomycin, 167varicella-zoster virus, and isolated angiitis of

central nervous system, 201vascular congestion, and ischemic strokes, 237vascular dementia, and microangiopathic

lesions, 241vascular disease, 254

risk factors, 104vascular hypothesis, 194–5vascular nidus, 227vasculitis

use of term, 201see also cerebral vasculitis

vasogenic edema, 235venous thrombosis (VT), risk factors, 96ventricular arrhythmias, triggers, 9vertebral artery, 60vertebral artery dissections, 82–3

etiology, 184incidence, 183and stroke, 184–5see also bilateral vertebral artery dissections

vertebral dissectionwith hemodynamic infarction in centre of

cerebellar vermis, 82–5clinical history, 82diagnostic issues, 84–5examination, 82studies, 82–3symptoms, 84

vertebral infarctions, 77vertigo, 68, 82

rotatory, 182sudden onset, 84without motion related patterns, 84–5see also dizziness

vestibular neuronitis, 182viral diseases, and isolated angiitis of central

nervous system, 201Virchow-Robin spaces, 15visual symptoms, in acute stroke, 28–9vomiting, 47, 56, 62, 162, 164, 207von Recklinghausen’s disease

see Recklinghausen’s disease

Wallenberg, Adolf, 62Wallenberg’s syndrome

symptoms, 61use of term, 62see also lateral medullary syndrome

warfarin, 224, 256in cerebral venous thrombosis treatment, 50guidelines, 33in Sneddon syndrome treatment, 180

white matterabnormalities, 208changes, 57and cerebral amyloid angiopathy, 160–1

white matter lesions (WMLs), 15, 19, 187detection, 69–70supratentorial, 67–70see also cerebral white matter lesions

World Federation of Neurological Surgeons,grading system, 59

x-rays, chest, 2

Yamamoto, Rokushu, 216–17

Zweig, Stefan, George Frederick Handel’sResurrection, 1

272 Index






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