Chapters authored
Cerebral Vein and Dural Sinus Thrombosis
Cerebral venous thrombosis (CVT) is an uncommon disorder in the general population. At least 1 risk factor can be identified in 85% of patients with CVT. Because of the high frequency of thrombophilia among patients with CVT, screening for hypercoagulable conditions should be performed. Two pathophysiological mechanisms contribute to their highly variable clinical presentation. Four major syndromes have been described: isolated intracranial hypertension, focal neurological abnormalities, seizures, and encephalopathy. Cavernous sinus thrombosis represents the single CVT which produces a characteristic clinical syndrome. Head Computed Tomography is the most frequently performed imaging study, but Magnetic Resonance Imaging of the head combined with Magnetic Resonance venography are the most sensitive studies. Acute phase therapy for CVT focuses on anticoagulation, management of seizures, increased intracranial pressure, and prevention of cerebral herniation. The majority of patients have a complete or partial recovery, however they have an increased incidence of venous thromboembolism. Clinical and imaging follow-ups 3–6 months after diagnosis are recommended to assess for recanalization.
Part of the book: Ischemic Stroke of Brain
Clinical Presentation of Myasthenia Gravis
Despite advances in applied sciences, myasthenia gravis (MG) remains a challenging disorder to diagnose and treat. The clinical presentation results in either transient or persistent painless weakness and abnormal fatigability of any (ocular, bulbar, limbs, trunk, respiratory) or all voluntary (skeletal) muscles; however, it is usually not to the same extent. Several scoring systems of MG signs or the global state of the patient have been proposed in an attempt to provide a standard scheme for use by all investigators. Some patients may have non-muscle-related complaints due to different disorders which may be associated with MG (thymoma, thyroid disorders, other autoimmune diseases, etc.).
Part of the book: Thymus
Diagnosis of Symptomatic Intracranial Atherosclerotic Disease
Intracranial atherosclerotic stroke differs from extracranial atherosclerotic stroke in many aspects, including risk factors and stroke patterns. It occurs in association with in situ thrombotic occlusion, artery-to-artery embolism, branch occlusion, and hemodynamic insufficiency. Intracranial atherosclerotic stenosis (ICAS) could have only been diagnosed by transcranial Doppler (TCD) and transcranial color-coded sonography (TCCS), which are burdened by a risk of bias, or catheter angiography (DSA), which, on the contrary, is very precise, but rarely it is done in clinical practice due to its invasiveness. Computed tomography angiography (CT-A) and magnetic resonance imaging angiography (MR-A) have increased the identification of ICAS in a wider stroke population.
Part of the book: New Insight into Cerebrovascular Diseases