RT Book, Section
A1 Schwartz, Hope
A1 Sullivan, John
A1 Talmasov, Daniel
A1 Safar, Laura T.
A2 Silbersweig, David A.
A2 Safar, Laura T.
A2 Daffner, Kirk R.
SR Print(0)
ID 1178763220
T1 The Neuropsychiatry of Stroke
T2 Neuropsychiatry and Behavioral Neurology: Principles and Practice
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781260117103
LK neurology.mhmedical.com/content.aspx?aid=1178763220
RD 2024/04/18
AB Stroke  is  the  fifth  leading  cause  of  death  in  the  United  States  and  an  important  cause  of  disability.  Every  year,  about  795,000  people  in  the  United  States  have  a  stroke.  About  610,000  of  these  are  first  or  new  strokes;  185,000  are  recurrent  strokes.1  Stroke  is  characterized  by  the  sudden  occurrence  of  a  neurologic  deficit  or  syndrome.  Typically,  especially  as  it  pertains  to  physical  symptoms,  the  resultant  neurologic  syndrome  corresponds  to  the  portion  of  the  brain  supplied  by  the  respective  cerebral  vessels  affected  by  the  stroke  (see  Figures  22-1  and  22-2).  Strokes  are  broadly  categorized  as  ischemic  or  hemorrhagic.2  The  underlying  cause  of  the  vascular  occlusion  in  ischemic  strokes  may  be:  (i)  atherosclerosis  with  superimposed  thrombosis,  affecting  large  cerebral  or  extracerebral  blood  vessels  (Figure  22-3),  (ii)  cerebral  embolism,  and  (iii)  occlusion  of  small  cerebral  vessels  within  the  parenchyma  of  the  brain.  Alternative  pathologic  processes  that  may  result  in  ischemic  brain  damage  include  arterial  dissection,  inflammatory  conditions  such  as  vasculitis,  thrombosis  of  cerebral  veins,  and  dural  sinuses,  thrombosis  of  cerebral  vessels  due  to  hypercoagulable  conditions,  vasospasm,  and  other  mechanisms.  Hemorrhagic  strokes  (Figure  22-4)  are  caused  by  the  rupture  of  blood  vessels  and  subsequent  bleeding  into  the  brain  parenchyma  (intracerebral  hemorrhage)  or  the  subarachnoid  space  (Figure  22-5).  Contributing  factors  to  hemorrhagic  strokes  are  weakened  blood  vessels,  for  instance  due  to  aneurysms  or  arteriovenous  malformations,  and  hypertension.  Hemorrhagic  strokes  typically  do  not  respect  vascular  territories  and  thus  may  result  in  more  complex  syndromes.