Acute Stroke: Bench to Bedside PDF

Preface

As the third leading cause of death in the United States, stroke constitutes a national health problem. Stroke accounts for 1 in every 15 deaths and is the major cause of disability in the country. Presently, in excess of 4 million Americans are stroke survivors. In the past, care for stroke patients had been mixed with an element of nihilism. However, over the last 2 decades, major advances have been made, and practices that were largely based on anecdotal experiences and physiologic inferences have evolved into more refi ned procedures and protocols in the management of this patient population.

Laboratory-based research in animal models has enhanced our understanding of pathophysiologic mechanisms of brain injury and provided important insights for possible therapeutic strategies and targets. Advances in neuroimaging and neurointerventional techniques have provided multiple avenues and improved approaches to early diagnosis and therapy in the acute phase of stroke. Clinical research with neuroprotective trials in focal ischemic stroke, though disappointing thus far, have further heightened the need for a multifaceted approach that concentrates equally on early recognition, diagnosis, and aggressive treatment. But stroke is more than just cerebral ischemia. Our understanding of the pathophysiology of brain injury following intracerebral and subarachnoid hemorrhage continues to grow from laboratory-based experimental work. Collaborative care by a specially trained team of neurointensivists, neurosurgeons, anesthesiologists, and nurses, and the advent of newer monitoring techniques in a dedicated neuro-intensive care unit have improved outcomes in patients with these subtypes of stroke.

While numerous textbooks on stroke are available, a large gap exists between basic science bench research and its translation into patient care in the fi eld. The purpose of this book is to bridge this gap and present relevant bench research of "translational" signifi - cance, as well as its logical import, to the bedside. Each of the fi rst 4 sections of the book begins with a chapter that covers research in the particular subarea, using appropriate animal models, and progresses through a continuum of the disease, from pathophysiology to clinical management to prognosis. The last section discusses controversies and future directions in stroke care, and it is hoped that the reader will be stimulated to investigate the many unanswered questions. Our intent with this book is to present a comprehensive review on the subject and provide clinicians, neuroscientists, and clinician scientists with a guide that will foster research of translational signifi cance from bench to bedside and vice versa in this important area. We hope that we have achieved our goal.

We, the editors, are indebted to the authors for their valuable contributions. Special thanks are due to Tzipora Sofare, MA, for her efforts in editing this volume. Her close attention to detail and never-ending quest for accuracy and consistency have greatly contributed to its quality. We would also like to particularly express our thanks to the Johns Hopkins Clinician Scientist Program, the American Heart Association, the National Stroke Association, and the National Institutes of Health extramural programs, which have supported our investigative work and fellowship training programs in stroke and neurosciences critical care.