Stroke is a major public health issue, because of its high incidence rate, high case fatality rate, risk of residual physical and neuropsychological disabilities, and direct and indirect costs. Many strokes are preventable and treatable in the acute stage, provided that patients are admitted soon enough. The term stroke covers a wide range of heterogeneous disorders, depending on the severity of the clinical presentation, from transient deficits to severe cases with coma and early death; the underlying mechanism, i.e., cerebral ischemia, parenchymal hemorrhage, subdural hemorrhage, or subarachnoid hemorrhage (SAH); and the cause, i.e., atherosclerosis, cardioembolism, small-vessel occlusion, rare vasculopathies and undetermined causes in cerebral ischemia, or vascular malformations, cerebral amyloid angiopathies, small-vessel diseases, rare vasculopathies and undetermined causes in parenchymal hemorrhages. This chapter will focus only on acute cerebral ischemia and parenchymal hemorrhage. We will cover the general assessment of stroke patients, the complications that can occur in the acute stage, the treatment of acute stroke, and finally a few situations that require specific managements and where evidence-based data are scarce.
Part of the book: Ischemic Stroke
Cerebral vessels constriction is one of the leading causes of mortality and disability in patients with acute cerebral circulatory disorders. The most dangerous type of acute cerebrovascular disease accompanied by high mortality is ruptured cerebral aneurysms with subarachnoidal hemorrhage (SAH). Following a constriction of the cerebral vessels on the background of SAH is the reason for brain ischemia. This chapter will focus on the mechanisms of formation of cerebral vascular spasm, pathomorphological aspects of the cerebral vessels constriction, and the stages of vascular spasm—the development of constrictive-stenotic arteriopathy, contractural degeneration of smooth muscle cells, and endothelial damage. We will cover classifications of cerebral vessels constriction by prevalence and severity, modern methods of clinical and instrumental diagnostics and treatment including paroxysmal sympathetic hyperactivity syndrome associated with the development of secondary complications, a longer stay of the patients in the ICU, higher disability and mortality.
Part of the book: Cerebrovascular Diseases
The chapter is devoted to the control and management of the autonomic nervous system during general anesthesia in neurosurgery. The brainstem and supratentorial cerebral centers of autonomic regulation are the most important structures for control and management during general anesthesia using pharmacological defense with α2-adrenergic agonists and opioid analgesics. We discuss the questions of the depth of anesthesia (BIS-monitoring) and antinociceptive defense, variability of heart rate (variational cardiointervalometry), hemodynamic monitoring during neurosurgical operation, intraoperative thermometry, the meaning of trigeminocardiac reflex and its classification in neurosurgery, perioperative events causing autonomic distress syndrome development and methods of its prophylaxis and treatment, pathomorphological signs of vegetative distress syndrome. Control of the neuromuscular block and photoplethysmography assessment of perfusion index (PI) as methods of the adequacy of general anesthesia and neurovegetative stability.
Part of the book: Autonomic Nervous System