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Chapter 35 - Cerebrovascular disease

from Section 11 - Neurology

Published online by Cambridge University Press:  05 September 2013

By
Kumiko Owada ,
Duncan Borland  and
Michael Frankel
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Stroke affects 795,000 people each year in the USA and is a leading cause of long-term disability in the adult population. The impact of stroke on society is large not only because of the medical cost of acute care but also due to the cost of long-term disability. Stroke also has a significant impact on individual quality of life. In the past decade there have been considerable advances in treatment and prevention of stroke. Some of the incidence of stroke is associated directly or indirectly with surgical procedures. This chapter will review the mechanisms of stroke associated with surgical procedures and the issues surrounding management of stroke relevant to surgical patients.

Pathophysiology

Stroke can be divided into two types; ischemic and hemorrhagic. Ischemic stroke comprises about 87% of all strokes. Hypoperfusion in the brain tissue associated with either arterial occlusion or decreased blood flow causes ischemia that will progress with time to infarction. The concept of “penumbra” represents brain tissue which suffers from acute hypoperfusion but has yet to suffer cell death. The penumbra represents salvageable brain tissue that may be amenable to reperfusion therapy. Available therapeutic modalities for acute stroke focused on salvaging penumbra are discussed in the section below.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 387 - 395
Publisher: Cambridge University Press
Print publication year: 2013

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