Strokes most commonly develop in the presence of vascular or cardiac changes based on lifestyle-related diseases, such as hypertension, diabetes mellitus and hyperlipidemia. Therefore, the prevention of the progression of vascular or cardiac changes has to be taken into consideration in the acute phase of stroke treatment and in the chronic management of such stroke patients. Apart from the common types, there are special types of strokes which are not based on lifestyle-related diseases, such as cerebrovascular changes caused by physical pressure, cerebrovascular lesions of unknown cause, congenital cardiovascular abnormalities, or blood vessel inflammation. The representative cases are hemorrhagic or ischemic stroke associated with intracranial/extracranial arterial dissection, stroke associated with moyamoya disease (occlusion of the circle of Willis), paradoxical cerebral embolism, cerebral venous/sinus thrombosis, cerebral amyloid angiopathy, fibromuscular dysplasia, and aortitis syndrome. When treating these conditions, special strategies and particular attention or specific surgical treatments are often required, different from those for general stroke based on lifestyle-related diseases. For instance, in cases of cerebral infarction due to moyamoya disease administration of tissue plasminogen activator (t-PA), a thrombolytic drug, is prohibited, even if the patient’s arrival at the stroke care unit is 1-2 hours after onset.1 Likewise, in cases of infarction occurring due to intracranial cerebral arterial dissection, careful attention is needed to choose the administration of antiplatelet or anticoagulant agents during the acute phase.2,3 In the Japanese Guidelines for the Management of Stroke 2009, these special types of cerebrovascular disorders are grouped under “Other types of cerebrovascular disorders” separately from general cerebral infarction, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), and their treatment guidelines are documented individually in this chapter. The “other types of cerebrovascular disorders” include also hypertensive encephalopathy, vascular dementia and vascular cognitive impairment.
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© 2011 Published by Elsevier Inc.