The Ischemic Penumbra presents the current status of concepts and research on this topic and identifies the latest methods for clinicians to quickly and efficiently recognize viable cerebral tissue for enhanced stroke management. Focusing on state-of-the-science technologies and current trends, the book examines imaging strategies utilizing PET, SP

The ischemic penumbra was initially defined by Symon, Lassen and colleagues in the 1970s as an area of brain tissue with inadequate blood flow to maintain electric activity of neurons but adequate blood flow to preserve the function of the ion channels. This area of tissue, receiving enough blood to survive but not enough to function, often surrounds or abuts the irreversibly damaged core in ischemic stroke. It was shown that if blood flow could be restored to this area of marginal perfusion, the tissue could survive and function again, and growth of the core could be prevented. Based on seminal PET studies, penumbra or "penumbral tissue" eventually took on a subtly different meaning - the area of brain that is destined to progress to infarct unless blood flow is restored within a particular time window. The penumbra thus became the target for all acute stroke interventions - to preserve viability of the tissue and restore function. New imaging techniques, including diffusion and perfusion MRI and CT perfusion, were developed to rapidly identify individuals with penumbra, who were thought to be the best candidates for aggressive interventions to restore blood flow, particularly beyond the licensed time-window for IV thrombolysis. However, most clinical trials have failed to establish the usefulness of identifying candidates for treatment in this way using pre-specified protocols and primary endpoints. These trials have used different and sometimes unvalidated thresholds of hypoperfusion as well as irreversible infarct and various definitions of significant penumbra (or mismatch between irreversible infarct and hypoperfused, but salvageable tissue), and reanalysis of their data using more refined image processing showed post-hoc positivity. They have also evaluated outcome in a variety of ways, with few studies measuring the direct effect of restoring blood flow on the function of the penumbral tissue. Therefore, important remaining questions include how to define, characterize, and image the penumbra in acute stroke to achieve the greatest reliability and validity for what we want to measure, and whether this concept, so defined, provides an optimal target for stroke therapy using state-of-the-art trial design.

This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.

Despite significant technological advances in recent years, their impact on our overall health and social, well-being is not always clear to see. Perhaps, one of the best examples of this can be highlighted by the fact that mortality rates as a result of cerebrovascular diseases have hardly changed, if at all. This places cerebrovascular diseases as one of the most prominent causes of both disability and death. In Cuba, for instance, a total of 22,000 cases of cerebrovascular diseases are reported each year in a country where life expectancy should increase to 80 years in the near future. In such a situation, to have a book that includes in a clear and summarized way, a group of topics directly related to the preclinical investigations advances and the therapeutic procedures for the cerebrovascular disease in its acute phase constitutes a useful tool for the wide range of the contributors to this affection's problems solution. In this group is included students, professors, researchers, and health policy makers whose work represents one of the greatest social and human impact challenges of the XXI century basic and clinical neurosciences.

Now in its thoroughly updated Fourth Edition, the Hypertension Primer is a comprehensive, readable source of state-of-the-art scientific and clinical information on hypertension. The book contains 171 short chapters by distinguished experts that cover every aspect of hypertension and its pathogenesis, epidemiology, impact, and management. Highlights of this edition include updated JNC 7 findings regarding special population therapy and clinical management. Chapters are grouped into three well-organized sections—basic science, population science, and clinical management—and each chapter is cross-referenced to other relevant chapters. Each chapter is easily digestible and begins with a bulleted list of key points.

Brain Hypoxia and Ischemia explores the various aspects of cell death and survival that are crucial for understanding the basic mechanisms underlying brain hypoxia and ischemia. Chapters focus on a panorama of issues including the role of ion channels/transporters, mitochondria and apoptotic mechanisms, the roles of glutamate/NMDA, mechanisms in penumbral cells and the importance of intermittent hypoxia and gene regulation under these stressful conditions. The volume explores findings from both mammalian and invertebrate model systems and their applicability to human systems and diseases. Careful consideration is also given to differences in hypoxia and ischemia across development. This volume aims to increase the understanding of these mechanisms and to stimulate research on better diagnosis and treatment of diseases that afflict the brain and potentially other organs when O2 levels are dysregulated. Brain Hypoxia and Ischemia is designed for neuroscientists, clinicians and medical/graduate students for use in both basic research and clinical practice.

Stroke MRI is a new imaging tool providing detailed information of the pathophysiological aspects of cerebral ischemia. This book - with CD-ROM - includes a case collection of 25 hyperacute stroke patients, all imaged within six hours of stroke onset with a complete stroke MRI protocol. Stroke MRI and the established clinical methods are compared and recent results from single and multicenter trials are presented to demonstrate the advantages of MRI for stroke patients. The CD-ROM contains diffusion-, T2-, T2*-perfusion-weighted images and MR angiography. The CD and the book are complementary to avoid redundancy as far as possible.

This focused book deals clearly and concisely with the principles of management of patients with acute ischemic stroke (AIS). It emphasizes the published and verifiable evidence in support of these principles, and highlights the areas of limited evidence. Best evidence is provided for the current standard treatment of acute ischemic stroke, including intravenous chemical thrombolysis, intra-arterial approaches, blood pressure management, and anti-thrombotic therapy. More modern techniques are also described, such as the use of mechanical devices to evacuate a thrombus, induced hypertension, hyper-oxygenation (hyperoxia), and neuroprotective or neuroregeneration agents. Hallmark features include: Focused on acute ischemic stroke, the most rapidly growing area of stroke management Evidence based: Provides best evidence for treatment Clearly discusses areas and topics where best evidence has not yet been established Lays out treatment plans and protocols in handbook fashion for ease of use and reference, even in emergency situations Includes latest and cutting-edge techniques and equipment for dealing with AIS Acute Ischemic Stroke: An Evidence-based Approach is an indispensable reference work for neurologists, neurocritical care medics, intensivists, hospitalists, emergency room physicians, neurology residents and fellows. It is also a helpful resource for medical students, physician assistants, and nurse practitioners in hospital and neurocritical care facilities.

More than 300 diagnoses that are delineated, referenced, and lavishly illustrated highlight the third edition of this bestselling reference. World-renowned authority Dr. Anne G. Osborn and her expert author team of Drs. Karen L. Salzman and Miral D. Jhaveri provide carefully updated information in a concise, bulleted format, keeping you current with new disease entities and syndromes, MR imaging techniques and applications, and pathology relevant to brain imaging. Succinct text, outstanding illustrations, and up-to-date content make this title a must-have reference for neuroradiologists, general radiologists, neurologists, and neurosurgeons. Concise, bulleted text provides efficient information on more than 300 diagnoses that are clearly illustrated with 2,500 superb images Meticulously updated throughout, with new diagnoses and hundreds of new images that provide the most current information in the field. Expert guidance on CLIPPERS, second-impact syndrome in trauma, perfusion MR for tumor characterization, susceptibility-weighted imaging in stroke and brain bleeds, and molecular markers in brain tumor classification and grading. Updated coverage of brain trauma addresses newly recognized entities, techniques and imaging for rapid stroke triage, and functional imaging and dementia diagnosis.