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Ischemic Stroke

  • Jamary Oliveira-Filho
  • Jamary Oliveira-Filho
  • Walter J. Koroshetz

Abstract

Ischemic stroke is becoming an increasingly important condition for intensivists to recognize and manage in order to minimize the neurologic injury. It is a major public health issue because it is the third leading cause of death and the leading cause of adult disability. Devastating ischemic brain injury often strikes patients who are in the hospital for treatment of an unrelated medical or surgical condition. About 5–10% of acute strokes occur in the critical care and postoperative units, and on the hospital floors. Stroke that complicates another illness is a cause of increased in-hospital stay, mortality, and long-term morbidity.1 Stroke in the intensive care unit (ICU) can be classified into three major categories (Table 15.1) according to (1) the presence of a variety of adverse events associated with increased stroke risk, (2) the presence of conditions that cause critical care illnesses as well as ischemic stroke, and (3) stroke as the primary reason for critical care admission, seen much more frequently in the post-thrombolysis era. Postoperative stroke, though rarely seen after general surgery (0.08–2.9% of cases), occurs more frequently after cardiac or vascular procedures, and in patients with various cerebrovascular risk factors.

Keywords

Coronary Artery Bypass Grafting Middle Cerebral Artery Acute Stroke Carotid Stenosis Anterior Cerebral Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Roach GW, Kanchuger M, Mangano CM, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med. 1996;335:1857–1863.PubMedCrossRefGoogle Scholar
  2. 2.
    Limburg M, Wijdicks EF, Li H. Ischemic stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology. 1998;50:895–901.PubMedCrossRefGoogle Scholar
  3. 3.
    Hogue CW Jr, Murphy SF, Schechtman KB, Davila-Roman VG. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100:642–647.PubMedCrossRefGoogle Scholar
  4. 4.
    Tettenborn B, Caplan LR, Sloan MA, et al. Postoperative brainstem and cerebellar infarcts. Neurology. 1993;43:471–477.PubMedCrossRefGoogle Scholar
  5. 5.
    Redmond JM, Greene PS, Goldsborough MA, et al. Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg. 1996;61:42–47.PubMedCrossRefGoogle Scholar
  6. 6.
    Ay H, Buonanno FS, Rordorf G, et al. Normal diffusion-weighted MRI during stroke-like deficits. Neurology. 1999;52:1784–1792.PubMedCrossRefGoogle Scholar
  7. 7.
    Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.PubMedCrossRefGoogle Scholar
  8. 8.
    Wijdicks EF, Plevak DJ, Wiesner RH, Steers JL. Causes and outcome of seizures in liver transplant recipients. Neurology. 1996;47:1523–1525.PubMedCrossRefGoogle Scholar
  9. 9.
    Ay H, Buonanno FS, Schaefer PW, et al. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI. Neurology. 1998;51:1369–1376.PubMedCrossRefGoogle Scholar
  10. 10.
    Mansoor GA, White WB, Grunnet M, Ruby ST. Intracerebral hemorrhage after carotid endarterectomy associated with ipsilateral fibrinoid necrosis: a consequence of the hyperperfusion syndrome? J Vasc Surg. 1996;23:147–151.PubMedCrossRefGoogle Scholar
  11. 11.
    Ross T. Transient tumor attacks. Arch Neurol. 1983;40:633–636.PubMedCrossRefGoogle Scholar
  12. 12.
    Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke 1990;21:637–676.Google Scholar
  13. 13.
    Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol. 2005;58(5):688–697.PubMedCrossRefGoogle Scholar
  15. 15.
    Ygge J. Changes in blood coagulation and fibrinolysis during the postoperative period. Am J Surg. 1970;119:225–232.PubMedCrossRefGoogle Scholar
  16. 16.
    Rem J, Feddersen C, Brandt MR, Kehlet H. Postoperative changes in coagulation and fibrinolysis independent of neurogenic stimuli and adrenal hormones. Br J Surg. 1981;68:229–233.PubMedCrossRefGoogle Scholar
  17. 17.
    Modig J, Borg T, Bagge L, Saldeen T. Role of extradural and of general anaesthesia in fibrinolysis and coagulation after total hip replacement. Br J Anaesth. 1983;55:625–629.PubMedCrossRefGoogle Scholar
  18. 18.
    Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med. 1997;336:1506–1511.PubMedCrossRefGoogle Scholar
  19. 19.
    Brugieres P, Castrec-Carpo A, Heran F, Goujon C, Gaston A, Marsault C. Magnetic resonance imaging in the exploration of dissection of the internal carotid artery. J Neuroradiol. 1989;16:1–10.PubMedGoogle Scholar
  20. 20.
    Gelbert F, Assouline E, Hodes JE, et al. MRI in spontaneous dissection of vertebral and carotid arteries. 15 cases studied at 0.5 tesla. Neuroradiology. 1991;33:111–113.PubMedCrossRefGoogle Scholar
  21. 21.
    Ziser A, Adir Y, Lavon H, Shupak A. Hyperbaric oxygen therapy for massive arterial embolism during cardiac operations. J Thorac Cardiovasc Surg. 1999;117:818–821.PubMedCrossRefGoogle Scholar
  22. 22.
    Young ML, Smith DS, Murtagh F, Vasquez A, Levitt J. Comparison of surgical and anesthetic complications in neurosurgical patients experiencing venous air embolism in the sitting position. Neurosurgery. 1986;18:157–161.PubMedCrossRefGoogle Scholar
  23. 23.
    Moorthy SS, Tisinai KA, Speiser BS, Cikrit DF, Dierdorf SF. Cerebral air embolism during removal of a pulmonary artery catheter. Crit Care Med. 1991;19:981–983.PubMedCrossRefGoogle Scholar
  24. 24.
    Takahashi M, Suzuki R, Osakabe Y, et al. Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma. 1999;46:324–327.PubMedCrossRefGoogle Scholar
  25. 25.
    Hofmann S, Huemer G, Salzer M. Pathophysiology and management of the fat embolism syndrome. Anaesthesia. 1998;53(Suppl 2):35–37.PubMedGoogle Scholar
  26. 26.
    Byrick RJ, Mullen JB, Mazer CD, Guest CB. Transpulmonary systemic fat embolism. Studies in mongrel dogs after cemented arthroplasty. Am J Respir Crit Care Med. 1994;150:1416–1422.PubMedCrossRefGoogle Scholar
  27. 27.
    Chastre J, Fagon JY, Soler P, et al. Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome in trauma patients. Ann Intern Med. 1990;113:583–588.PubMedCrossRefGoogle Scholar
  28. 28.
    Guenter CA, Braun TE. Fat embolism syndrome. Changing prognosis. Chest. 1981;79:143–145.PubMedCrossRefGoogle Scholar
  29. 29.
    Schwartz MW, McDonald GB. Cholesterol embolization syndrome. Occurrence after intravenous streptokinase therapy for myocardial infarction. JAMA. 1987;258:1934–1935.PubMedCrossRefGoogle Scholar
  30. 30.
    Khaffaf N, Karnik R, Winkler WB, Valentin A, Slany J. Embolic stroke by compression maneuver during transcranial Doppler sonography. Stroke. 1994;25:1056–1057.PubMedCrossRefGoogle Scholar
  31. 31.
    Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet. 1999;354:1594–1597.PubMedCrossRefGoogle Scholar
  32. 32.
    Truwit CL, Barkovich AJ, Gean-Marton A, Hibri N, Norman D. Loss of the insular ribbon. Another early sign of acute middle cerebral artery infarction. Radiology. 1990;176:801–806.PubMedGoogle Scholar
  33. 33.
    Von Kummer R, Meyding-Lamade U, Forsting M, et al. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR Am J Neuroradiol. 1994;15:9–18.Google Scholar
  34. 34.
    Wardlaw JM, Lewis SC, Dennis MS, Counsell C, McDowall M. Is visible infarction on computed tomography associated with an adverse prognosis in acute ischemic stroke? Stroke. 1998;29:1315–1319.PubMedCrossRefGoogle Scholar
  35. 35.
    Marks MP, Holmgren EB, Fox AJ, Patel S, von Kummer R, Froelich J. Evaluation of early computed tomographic findings in acute ischemic stroke. Stroke. 1999;30:389–392.PubMedCrossRefGoogle Scholar
  36. 36.
    Gonzalez RG, Schaefer PW, Buonanno FS, et al. Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset. Radiology. 1999;210:155–162.PubMedGoogle Scholar
  37. 37.
    Katz DA, Marks MP, Napel SA, Bracci PM, Roberts SL. Circle of Willis: evaluation with spiral CT angiography, MR angiography and conventional angiography. Radiology. 1995;195:445–449.PubMedGoogle Scholar
  38. 38.
    Wildermuth S, Knauth M, Brandt T, Winter R, Sartor K, Hacke W. Role of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke. 1998;29:935–938.PubMedCrossRefGoogle Scholar
  39. 39.
    Lövblad KO, Laubach HJ, Baird AE, et al. Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol. 1998;19:1061–1066.PubMedGoogle Scholar
  40. 40.
    van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP. Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke. 1998;29:1783–1790.PubMedCrossRefGoogle Scholar
  41. 41.
    Barber PA, Darby DG, Desmond PM, et al. Identification of major ischemic change. Diffusion-weighted imaging versus computed tomography. Stroke. 1999;30:2059–2065.PubMedCrossRefGoogle Scholar
  42. 42.
    Moseley ME, Kucharczyk J, Mintorovitch J, et al. Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol. 1990;11:423–429.PubMedGoogle Scholar
  43. 43.
    Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME. Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology. 1998;50:864–870.PubMedCrossRefGoogle Scholar
  44. 44.
    Rordorf G, Koroshetz WJ, Copen WA, et al. Regional ischemia and ischemic injury in patients with acute middle cerebral artery stroke as defined by early diffusion-weighted and perfusion-weighted MRI. Stroke. 1998;29:939–943.PubMedCrossRefGoogle Scholar
  45. 45.
    Barber PA, Davis SM, Darby DG, et al. Absent middle cerebral artery flow predicts the presence and evolution of the ischemic penumbra. Neurology. 1999;52:1125–1132.PubMedCrossRefGoogle Scholar
  46. 46.
    Jansen O, Schellinger P, Fiebach J, Hacke W, Sartor K. Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet. 1999;353:2036–2037.PubMedCrossRefGoogle Scholar
  47. 47.
    Alexandrov AV, Demchuk AM, Wein TH, Grotta JC. Yield of transcranial Doppler in acute cerebral ischemia. Stroke. 1999;30:1604–1609.PubMedCrossRefGoogle Scholar
  48. 48.
    Demchuk AM, Christou I, Wein TH, et al. Specific transcranial Doppler flow findings related to the presence and site of arterial occlusion. Stroke. 2000;31:140–146.PubMedCrossRefGoogle Scholar
  49. 49.
    Alexandrov AV, Demchuk AM, Felberg RA, et al. High rate of complete recanalization and dramatic clinical recovery during tPA infusion when continuously monitored with 2-MHz transcranial Doppler monitoring. Stroke. 2000;31:610–614.PubMedCrossRefGoogle Scholar
  50. 50.
    Alexandrov AV, Molina CA, Grotta JC, et al. CLOTBUST Investigators. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med. 2004;351(21):2170–2178.PubMedCrossRefGoogle Scholar
  51. 51.
    Eggers J, Seidel G, Koch B, König IR. Sonothrombolysis in acute ischemic stroke for patients ineligible for rt-PA. Neurology. 2005;64(6):1052–1054.PubMedCrossRefGoogle Scholar
  52. 52.
    Brandt T, Knauth M, Wildermuth S, et al. CT angiography and Doppler sonography for emergency assessment in acute basilar artery ischemia. Stroke. 1999;30:606–612.PubMedCrossRefGoogle Scholar
  53. 53.
    Rordorf G, Cramer SC, Efird JT, Schwamm LH, Buonanno F, Koroshetz WJ. Pharmacological elevation of blood pressure in acute stroke. Clinical effects and safety. Stroke. 1997;28:2133–2138.PubMedCrossRefGoogle Scholar
  54. 54.
    Oliveira-Filho J, Silva SC, Trabuco CC, Pedreira BB, Sousa EU, Bacellar A. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset. Neurology. 2003;61:1047–1051.PubMedCrossRefGoogle Scholar
  55. 55.
    Rodríguez-García JL, Botia E, de La Sierra A, Villanueva MA, González-Spínola J. Significance of elevated blood pressure and its management on the short-term outcome of patients with acute ischemic stroke. Am J Hypertens. 2005;18(3):379–384.PubMedCrossRefGoogle Scholar
  56. 56.
    Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38(5):1655–1711.PubMedCrossRefGoogle Scholar
  57. 57.
    Ginsberg MD, Busto R. Combating hyperthermia in acute stroke: a significant clinical concern. Stroke. 1998;29:529–534.PubMedCrossRefGoogle Scholar
  58. 58.
    Castillo J, Davalos A, Marrugat J, Noya M. Timing for fever-related brain damage in acute ischemic stroke. Stroke. 1998;29:2455–2460.PubMedCrossRefGoogle Scholar
  59. 59.
    Reith J, Jorgensen HS, Pedersen PM, et al. Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet. 1996;347:422–425.PubMedCrossRefGoogle Scholar
  60. 60.
    Schwab S, Schwartz S, Spranger M, Keller E, Bertram M, Hacke W. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke. 1998;29:2461–2466.PubMedCrossRefGoogle Scholar
  61. 61.
    Anderson RE, Tan WK, Martin HS, Meyer FB. Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke. 1999;30:160–170.PubMedCrossRefGoogle Scholar
  62. 62.
    Gray CS, Hildreth AJ, Sandercock PA, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol. 2007;6(5):397–406.PubMedCrossRefGoogle Scholar
  63. 63.
    Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581–1587.Google Scholar
  64. 64.
    Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282:2019–2026.PubMedCrossRefGoogle Scholar
  65. 65.
    Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352:1245–1251.PubMedCrossRefGoogle Scholar
  66. 66.
    Furlan A, Higashida R, Wechsler L, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II Study: a randomized controlled trial. Prolyse in Acute Thromboembolism. JAMA. 1999;282:2003–2011.PubMedCrossRefGoogle Scholar
  67. 67.
    Smith WS, Sung G, Starkman S, et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke. 2005;36(7):1432–1438.PubMedCrossRefGoogle Scholar
  68. 68.
    Hoffmann M, Robbs J. Carotid endarterectomy after recent cerebral infarction. Eur J Vasc Endovasc Surg. 1999;18:6–10.PubMedCrossRefGoogle Scholar
  69. 69.
    Giordano JM. The timing of carotid endarterectomy after acute stroke. Semin Vasc Surg. 1998;11:19–23.PubMedGoogle Scholar
  70. 70.
    Paty PS, Darling RC 3rd, Woratyla S, Chang BB, Kreienberg PB, Shah DM. Timing of carotid endarterectomy in patients with recent stroke. Surgery. 1997;122:850–855.PubMedCrossRefGoogle Scholar
  71. 71.
    Qureshi AI, Luft AR, Janardhan V, et al. Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting. Stroke. 2000;31:376–382.PubMedCrossRefGoogle Scholar
  72. 72.
    Malek A, Higashida RT, Phatouros CC, et al. Treatment of posterior circulation ischemia with extracranial percutaneous balloon angioplasty and stent placement. Stroke. 1999;30:2073–2085.PubMedCrossRefGoogle Scholar
  73. 73.
    Gomez CR, Misra VK, Liu MW, et al. Elective stenting of symptomatic basilar artery stenosis. Stroke. 2000;31:95–99.PubMedCrossRefGoogle Scholar
  74. 74.
    Ringleb PA, Allenberg J, Brückmann H, et al. SPACE Collaborative Group. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial Lancet 2006;368:1239–1247.Google Scholar
  75. 75.
    Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355(16):1660–1671.PubMedCrossRefGoogle Scholar
  76. 76.
    Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351(15):1493–1501.PubMedCrossRefGoogle Scholar
  77. 77.
    Ohki T, Roubin GS, Veith FJ, Iyer SS, Brady E. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: an ex vivo analysis. J Vasc Surg. 1999;30:1034–1044.PubMedCrossRefGoogle Scholar
  78. 78.
    Vishteh AG, Marciano FF, David CA, Schievink WI, Zabramski JM, Spetzler RF. Long-term graft patency rates and clinical outcomes after revascularization for symptomatic traumatic internal carotid artery dissection. Neurosurgery. 1998;43:761–768.PubMedCrossRefGoogle Scholar
  79. 79.
    Koslow AR, Ricotta JJ, Ouriel K, O’Brian M, Green RM, Deweese JA. Reexploration for thrombosis in carotid endarterectomy. Circulation. 1989;80:III73–III78.PubMedGoogle Scholar
  80. 80.
    Dashe JF, Pessin MS, Murphy RE, Payne DD. Carotid occlusive disease and stroke risk in coronary artery bypass graft surgery. Neurology. 1997;49:678–686.PubMedCrossRefGoogle Scholar
  81. 81.
    Markus HS, Droste DW, Kaps M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using Doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation. 2005;111(17):2233–2240.PubMedCrossRefGoogle Scholar
  82. 82.
    Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial. The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. JAMA 1998;279:1265–1272.Google Scholar
  83. 83.
    The International Stroke Trial (IST): a randomized trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet 1997;349:1569–1581.Google Scholar
  84. 84.
    Camerlingo M, Salvi P, Belloni G, Gamba T, Cesana BM, Mamoli A. Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions. Stroke. 2005;36:2415–2420.PubMedCrossRefGoogle Scholar
  85. 85.
    Vahedi K, Hofmeijer J, Juettler E, Camerlingo M, Salvi P, Belloni G, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–222.PubMedCrossRefGoogle Scholar
  86. 86.
    McCrory DC, Goldstein LB, Samsa GP, Oddone EZ, Landsman PB, Moore WS, et al. Predicting complications of carotid endarterectomy. Stroke. 1993;24:1285–1291.PubMedCrossRefGoogle Scholar
  87. 87.
    Young B, Moore WS, Robertson JT, et al. An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Atherosclerosis Study. Stroke. 1996;27:2216–2224.PubMedCrossRefGoogle Scholar
  88. 88.
    John RJ, Choudhri AF, Weinberg AD, et al. Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting. Ann Thorac Surg. 2000;69:30–36.PubMedCrossRefGoogle Scholar
  89. 89.
    Khaitan L, Sutter FP, Goldman SM, et al. Simultaneous carotid endarterectomy and coronary revascularization. Ann Thorac Surg. 2000;69:421–424.PubMedCrossRefGoogle Scholar
  90. 90.
    Reed GL 3rd, Singer DE, Picard EH, DeSanctis RW. Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits. N Engl J Med. 1988;319:1246–1250.PubMedCrossRefGoogle Scholar
  91. 91.
    McKhann GM, Goldsborough MA, Borowicz LM Jr, et al. Predictors of stroke risk in coronary artery bypass patients. Ann Thorac Surg. 1997;63:516–521.PubMedCrossRefGoogle Scholar
  92. 92.
    Selim M. Perioperative stroke. N Engl J Med. 2007;356:706–713.PubMedCrossRefGoogle Scholar
  93. 93.
    Likosky DS, Marrin CA, Caplan LR, et al. Northern New England Cardiovascular Disease Study Group. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke 2003;34:2830–2834.Google Scholar
  94. 94.
    Brillman J. Central nervous system complications in coronary artery bypass graft surgery. Neurol Clin. 1993;11:475–495.PubMedGoogle Scholar
  95. 95.
    Ballotta E, Dagiau G, Saladini M, et al. Results of electroencephalographic monitoring during 369 consecutive carotid artery revascularizations. Eur Neurol. 1997;37:43–47.PubMedCrossRefGoogle Scholar
  96. 96.
    Braekken SK, Reinvang I, Russell D, Brucher R, Svennevig JL. Association between intraoperative cerebral microembolic signals and postoperative neuropsychological deficit: comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting. J Neurol Neurosurg Psychiatry. 1998;65:573–576.PubMedCrossRefGoogle Scholar
  97. 97.
    Hertzer NR, Loop FD, Beven EG, O’Hara PJ, Krajewski LP. Surgical staging for simultaneous coronary and carotid disease: a study including prospective randomization. J Vasc Surg. 1989;9:455–463.PubMedGoogle Scholar
  98. 98.
    Akins CW. Combined carotid endarterectomy and coronary revascularization operation. Ann Thorac Surg. 1998;66:1483–1484.PubMedCrossRefGoogle Scholar
  99. 99.
    Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarction: etiology and outcome. Neurology 1996;47:321–330; Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Experience with 1,509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 1993;17:357–370; Cambria RP, Davison JK. Regional hypothermia for prevention of spinal cord ischemic complications after thoracoabdominal aortic surgery: experience with epidural cooling. Semin Thorac Cardiovasc Surg 1998;10:61–65.Google Scholar
  100. 100.
    Acher CW, Wynn MM, Hoch JR, Kranner PW. Cardiac function is a risk factor for paralysis in thoracoabdominal aortic replacement. J Vasc Surg. 1998;27:821–828.PubMedCrossRefGoogle Scholar
  101. 101.
    Faig J, Busse O, Salbeck R. Vertebral body infarction as a confirmatory sign of spinal cord ischemic stroke: report of three cases and review of the literature. Stroke. 1998;29:239–243.PubMedCrossRefGoogle Scholar
  102. 102.
    Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997;277:1597–1604.PubMedCrossRefGoogle Scholar
  103. 103.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jamary Oliveira-Filho
    • 1
  • Jamary Oliveira-Filho
    • 2
  • Walter J. Koroshetz
    • 3
  1. 1.Neurology Service and Neurocritical Care UnitHospital EspanholBahiaBrazil
  2. 2.Federal University of BahiaSalvadorBrazil
  3. 3.National Institute of Neurological Disorders and StrokeBethesdaUSA

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