1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [49cac129-1d44-441f-9a9f-6b5e3d8f1fa8] => Array
        (
            [runtime-id] => 49cac129-1d44-441f-9a9f-6b5e3d8f1fa8
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [f7e94ebb-b7c9-418e-9c46-9e28319b6f4f] => Array
                        (
                            [runtime-id] => f7e94ebb-b7c9-418e-9c46-9e28319b6f4f
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [a3032b36-d782-4540-be8b-d5e59600b63b] => Array
        (
            [runtime-id] => a3032b36-d782-4540-be8b-d5e59600b63b
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [1fd02587-d841-439c-8fd7-48e440cc4115] => Array
                        (
                            [runtime-id] => 1fd02587-d841-439c-8fd7-48e440cc4115
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [13450878-992a-40e3-9785-00cade4b0ce2] => Array
        (
            [runtime-id] => 13450878-992a-40e3-9785-00cade4b0ce2
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [6e17310d-c66c-44b6-9916-e50d0b585371] => Array
                        (
                            [runtime-id] => 6e17310d-c66c-44b6-9916-e50d0b585371
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [49cac129-1d44-441f-9a9f-6b5e3d8f1fa8] => Array
        (
            [runtime-id] => 49cac129-1d44-441f-9a9f-6b5e3d8f1fa8
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [f7e94ebb-b7c9-418e-9c46-9e28319b6f4f] => Array
                        (
                            [runtime-id] => f7e94ebb-b7c9-418e-9c46-9e28319b6f4f
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [49cac129-1d44-441f-9a9f-6b5e3d8f1fa8] => Array
        (
            [runtime-id] => 49cac129-1d44-441f-9a9f-6b5e3d8f1fa8
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [f7e94ebb-b7c9-418e-9c46-9e28319b6f4f] => Array
                        (
                            [runtime-id] => f7e94ebb-b7c9-418e-9c46-9e28319b6f4f
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [49cac129-1d44-441f-9a9f-6b5e3d8f1fa8] => Array
        (
            [runtime-id] => 49cac129-1d44-441f-9a9f-6b5e3d8f1fa8
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [f7e94ebb-b7c9-418e-9c46-9e28319b6f4f] => Array
                        (
                            [runtime-id] => f7e94ebb-b7c9-418e-9c46-9e28319b6f4f
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [49cac129-1d44-441f-9a9f-6b5e3d8f1fa8] => Array
        (
            [runtime-id] => 49cac129-1d44-441f-9a9f-6b5e3d8f1fa8
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [f7e94ebb-b7c9-418e-9c46-9e28319b6f4f] => Array
                        (
                            [runtime-id] => f7e94ebb-b7c9-418e-9c46-9e28319b6f4f
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [10d3e9c7-3f75-4533-9a89-a1e34b18af85] => Array
        (
            [runtime-id] => 10d3e9c7-3f75-4533-9a89-a1e34b18af85
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [cec0e730-9bad-49b4-beb0-763a447eb67a] => Array
                        (
                            [runtime-id] => cec0e730-9bad-49b4-beb0-763a447eb67a
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;8c7bfe7517b32c2ca1bcb5bd2ad16467415182f5
                )

        )

)


  
    



























































    Neuroimaging Clinics of North America. Stroke I: Overview and Current Clinical Practice | American Journal of Neuroradiology  
    



















    































    
  
  




    
    

  

      


    

      

  
  
  

    

  

    

  

                
    

      

  

    

  
      
  
  

    


Advertisement



  



  


  
  



  



    

  


  


  


  
  
  
  
  
  

  	      


    
      

    
  
    
        
    

  

    
                        

  

                
    

      

	  

		
		

			

			  

  
      
  
  

    

  
  
      
Book ReviewBOOKS REVIEWS

  
      

  
      
Neuroimaging Clinics of North America. Stroke I: Overview and Current Clinical Practice
  
  
    	
American Journal of Neuroradiology August 2006,  27 (7) 1599-1600; 

  
  
  



  


  
  



			

		

	
	
 	
	  
  

		
		

			

			  

  
      
  
  

    
  


  
  



  
      
  
  

    

  

    

  
      
  
  

    

      Michael H. Lev, guest editor. Vol. 15, No. 2, May 2005. Philadelphia: WB Saunders. 240 pages, 121 illustrations, $84.95.
    
A decade after the approval and availability of thrombolytics for the treatment of acute ischemic stroke, there has been a significant expansion of the discipline of cerebrovascular diseases. Some stroke victims are being treated emergently, stroke centers are being formed, and vascular neurology has been recognized as a certified subspecialty. In neuroradiology, this has translated to a need for emergent imaging, the use of progressively more sophisticated technologies for imaging vessels and tissue at risk, and, significantly, endovascular therapeutic approaches. This book is a useful addition to the literature as it proposes how diagnostic evaluations of stroke victims should guide therapeutic interventions, emphasizing the pathophysiologic basis of imaging results.
Acute ischemic stroke treatment is anchored around intravenous tissue plasminogen activator (tPA), which is used within 3 hours of stroke onset when CT excludes a hemorrhage. Despite these advances, very few patients, approximately 2%, are being treated with thrombolytics; the main reason for this is the rigid timeframe in which intravenous tPA is used. Nonetheless, it is estimated that approximately 20% of stroke victims come to medical attention within 6 hours of onset, providing an opportunity to affect large numbers if effective therapy were available. A subgroup of patients with salvageable brain tissue responds to revascularization interventions beyond the 3-hour limit now imposed for intravenous thrombolysis. There is therefore a need to apply imaging techniques to determine tissue viability and guide acute treatment.
Consequently, it is fitting that this multiauthor, authoritative book is now available. Dr. Michael Lev and his contributors, in 15 well-written chapters, make a strong case for imaging based on the pathophysiology of vascular conditions to guide therapeutic interventions. Its multidisciplinary authors include neuroradiologists, neurologists, neurosurgeons, and interventionalists. This book is not comprehensive, in that it covers a smorgasbord of cerebrovascular topics that are mainly, though not exclusively, related to the role of imaging in the evaluation and treatment of stroke patients. The chapters are not overly technical and dwell mostly on the physiologic basis that guides imaging technique selection, interpretation, and application for clinical decision making. Therefore, this tome will be valuable not only for radiologists but also for all clinicians involved in the care of these patients.
Three excellent chapters discuss the role of CT in acute stroke. The early ischemic changes detected by CT and its impact on thrombolysis outcomes are discussed, and the combined use of parenchymal imaging with CT angiography and CT perfusion is reviewed. This is important because CT is the most widely available imaging technology in the emergency setting. Although MR imaging has many technical advantages, it will be many years until it is available routinely and in large scale in the emergency department. Nonetheless, available MR technology allows the detection of salvageable tissue and vascular patency, which is needed to make rational decisions on the need to acutely intervene. In fact, many centers are currently using multimodal MR imaging in acute stroke evaluation. The role of MR is extensively reviewed, including its use in the detection of early hemorrhage; in the past, CT was touted as superior to MR in the ability to distinguish blood products, but this is reviewed and refuted. The case that MR imaging is superior and may replace existing CT guidelines is proposed.
I agree with the suggestion made by various authors that a rigid time criterion for administering thrombolytic therapy should be replaced by a tissue viability assessment, and both MR and CT technology allow this determination. Early reports using tissue viability criteria rather than time criteria seem to validate this approach, and careful presentation of the thrombolytic experience is reviewed. Indeed, 2 algorithms, 1 for each technology, are proposed in the application of imaging to guide treatment, including a suggestion on treatment beyond the presently established recommendations for thrombolysis. A review of endovascular approaches for acute vascular reperfusion is presented in a clear manner, including the possibility of starting with intravenous therapy and following with intra-arterial interventions as “rescue” in the case of failed reperfusion. Overall, the reader will be left with a clear understanding of the role of imaging in acute ischemic stroke, the available therapeutic arsenal, and the role of cerebral and vascular imaging in guiding the use of these interventions.
Although a number of chapters are dedicated to acute intervention, this is not a manual of acute stroke assessment. A number of chapters deal with nonacute evaluations. Of note is a brief review of methods to assess vascular reserve and its application in clinical practice. This topic is not routinely covered in traditional neuroradiology overviews and allows an understanding of the basis of cerebral autoregulation. Similarly, a chapter on positron-emission tomography imaging of cerebral ischemia is a useful review of cerebral hemodynamics.
There are some unique areas covered in this book that are not routinely available in the clinical or radiologic literature of cerebrovascular diseases in this country. Two chapters address the burden and characteristics of stroke in Asia and Latin America. Hemorrhagic disease is more common in these populations, which is important to recognize because it may affect prophylactic measures, such as the use of antithrombotics in primary prevention. Similarly, the incidence of intracranial atherosclerotic disease is much greater in the Far East than in this country, which should guide diagnostic evaluations to include intracranial vascular imaging. Certain conditions that are uncommonly seen in the United States are discussed, including Moyamoya, Chagas disease, and neurocysticercosis. With our large and diverse immigrant communities, these issues are of particular consequence.
This is not an all-inclusive tome on the subject, and in some cases there is some repetitiveness in the coverage of certain topics. However, this book affords a fresh perspective on the need to evaluate tissue viability to guide therapy and has special pearls that will be memorable to those involved in the care of stroke patients.

      
    
Figure
  


  
  



  
      
  
  

    
  


  
  



  




  


  
  



  
      
  
  

    
  


  
  



  
      
  
  

     Back to top  


  
  



			

		

		
		

			

			  

  
        
In this issue

    
  
  

    
  


  
  



  
      
  
  

    

  

    

  
      
  
  

    


Advertisement



  



  


  
  



  



  


  
  



  
      
  
  

    

	  
  

		

          

            

  
      
  
  

     Print  


  
  



  
      
  
  

     Download PDF  


  
  



  
      
  
  

    
 Email Article
  


  
  



  
      
  
  

    
 Citation Tools
  


  
  



          

        

        
        

          

            



  
      
  
  

    

  

    

  
      
  
  

    

  
  
  
  
      
Neuroimaging Clinics of North America. Stroke I: Overview and Current Clinical Practice
  
  
    	
American Journal of Neuroradiology Aug 2006, 27 (7) 1599-1600; 

  
  
  



  


  
  



  
      
  
  

    

  
    
  
  
    
  
  
    
  


  


  
  



  
      
  
  

    
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  


  
  



  



  


  
  



  
      
  
  

    
  


  
  



          

        

	
 	
	
	


  


  
  



  
        
Jump to section

    
  
  

    
  


  
  



  
      
  
  

    

  

    
 Related Articles
  • No related articles found.
 Cited By...
  • No citing articles found.
 More in this TOC Section
 Similar Articles

  



  


  
  



			

		

	
	
 	
	
	


    

  



  

                
    

      

  

    

  
      
  
  

    


Advertisement