Ischemic cerebral vascular disease an overview

Abstract

SUMMARY -The management of patients with cerebrovascular ischemic disease (ICD) is rapidly changing due to newer diagnostic approaches and therapies being developed. In the present article, the author reviews part of his experience in the clinical and basic fields of ICD which is the most common neurologic problem leading to acute hospitalization. Clinico-anatomic categories of ICD as well as prognosis and differential diagnosis are discussed. Data from basic and research are analysed with a main focus on their implications for clinical management. Doença cerebrovascular isquêmica: uma avaliaçãoRESUMO -A doença cerebrovascular isquêmica (DCVI) representa a maior causa de hospitalização aguda por problemas neurológicos. Recentes avanços diagnósticos e terapêu-ticos, provenientes de pesquisa em áreas básicas, prometem modificar o atual panorama de desesperança terapêutica em curto prazo. No presente artigo, o autor revê parte de sua experiência no campo das DCVI e, com base em dados de pesquisa básica e clínica, discute aspectos essenciais de classificação, diagnóstico diferencial, prognóstico e tratamento, enfatizando o ponto de vista do clínico praticante à beira do leito.Ischemic cerebral vascular disease (ICD) is the most common neurologic problem leading to acute hospitalization.Yet, ICD has typically not been managed in an intensive care unit unless extenuating circumstances prevailed. Circumstances such as impaired consciousness with or without cerebral edema, crescendo transient ischemic attacks or evolving stroke, major associated illness (myocardial infarction, sepsis, pulmonary embolism) or LCD in a patient already in an intensive care unit (ICD complicates 1 to 2 percent of patients with acute myocardial infarction) have led to acute management. In the future we can anticipate that many more patients with ICD will be managed in a general intensive care unit or a specialized unit dedicated to intensive stroke care. This change will occur as newer therapies directed at the metabolic consequences of acute focal brain ischemia and fibrinolysis of offending cerebral arterial thrombi are developed. The treatment of ICD in many cases will require prompt diagnosis and the institution of appropriate therapy based upon the stroke subtype. Many of the newer therapies to be discussed will need careful assessment for therapeutic efficacy and side effects, a situation which will probably require an increase in the intensiveness of medical and nursing care. CATEGORIES OF ISCHEMIC CEREBROVASCULAR DISEASEDefining and categorizing ICD is necessary for accurate diagnosis and appropriate therapy.Three deggrees of completeness can be recognized: transient ischemic attacks (TIA), stroke-in-evolution, and completed stroke i*.JIA is an episode of temporary focal cerebral dysfunction occuring on a vascular basis which evolves