Adeolu Morawo

By Kathryn Grimes, Adam P. Klein, Rakhee Lalla, Adeolu Morawo, Sana Somani, Matthew J. Woodward and John W. Cole

Thromboses of the cerebral arterial and venous systems are a common manifestation of antiphospholipid syndrome (APS) often leading to ischemic and hemorrhagic stroke. APS increases stroke risk via many mechanisms, including hypercoagulability and inflammation. These mechanisms, among others, must be considered by physicians when evaluating and treating such patients to achieve optimal short- and long-term outcomes. In this chapter, we will discuss the epidemiology of APS as it relates to neurological disease focusing on stroke, APS stroke mechanisms, suggested clinical evaluations, acute treatment strategies, and long-term secondary stroke prevention strategies. Current consensus statements and the most recent literature will be summarized.

Part of the book: Antiphospholipid Syndrome

By Adeolu Morawo

Acute ischemic stroke imposes significant morbidity and mortality on patients and proves costly for the society. The most common pathophysiology involves the obstruction of a cerebral arterial vessel with a thrombus leading to distal ischemia which unrelieved proceeds to infarction. Intravenous thrombolysis has emerged as an effective and safe strategy for reperfusion and has been shown to increase the odds of a long-term favorable outcome. For more than 2 decades, the mainstay of intravenous thrombolysis has been Alteplase. More recently however, Tenecteplase is increasingly incorporated into routine practice, and it has been shown to be superior to Alteplase for recanalization in patients with large vessel occlusion, and at least non-inferior in patients without large vessel occlusion. Newer studies have expanded the time windows, introduced “the tissue clock”, and included patients that were previously considered ineligible for thrombolysis, altogether increasing the pool of stroke patients with favorable outcomes.

Part of the book: Stroke