Up-to-date discussion of the etiology, diagnosis, treatment, and prevention of this common cause of stroke and cognitive impairment.

An essential resource for diagnosis and treatment of stroke patients outside the usual clinical categories.

Recent advances in technology have opened up new possibilities in the diagnosis and treatment of cerebrospinal vascular diseases. It is now possible to use magnetic resonance imaging to map brain function and metabolism as an aid to diagnosis. Novel applications of magnetic resonance angiography allow three-dimensional imaging, and the magnetization transfer contrast technique gives us a new window on cerebral vascular function. This volume presents work in all these fields as well as previewing the techniques of endovascular surgery for cerebrospinal vascular diseases. These include modern stereotactic radiosurgery for arteriovenous malformations and for angiographically occult vascular malformations of the brain. This book presents an overview of the latest applications of technology to this rapidly developing and challenging field.

Fully revised throughout, the new edition of this concise textbook is aimed at doctors preparing to specialize in stroke care.

This work started out quite modestly as an investigation into the geographic distribution of cerebrovascular disease. But one question soon led to another and it just growed, like Topsy. In fact, it is hard to characterize precisely what this should be called. It is in part a Review of the Literature, in part a critique and reworking of other publications, and in part a standard view of stroke epidemio logy in the more restricted sense of attack and mortality rates and distribution. Still the result would I hope provide a synthesis of the population features of stroke as they appear to me at this time - a highly individual interpretation of the "state of the art". I have studiously avoided any survey of the history of cerebrovascular disease, and citations are for those of most recent vintage appropriate to the situation. Literature in this field continues to burgeon; my references end with the Fall of 1967. When counting noses we must have numbers, so the reader will find a massive compilation of tables. They are however necessary, especially since so many of my statements seem to fly in the face of current orthodoxy, whether lay or medical. With the data, one may decide for himself their validity. Insofar as possible tables have been placed in the appendix. Unless an author is directly quoted by me, all interpretations of his data are my own and he should be held blameless.

This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.