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INTRACEREBRAL AND SUBARACHNOID HEMORRHAGES
Rupture of vessels include two large categories. The more common is intracerebral hemorrhage (ICH), which results from chronic sustained hypertension and accounts for approximately 10 percent of all strokes. An infrequent cause of ICH is amyloid angiopathy; its cause (and cure) is unknown. A second category of vessel rupture is subarachnoid hemorrhage (SAH), most frequently due to aneurysmal rupture, but occasionally from arteriovenous malformations. SAH accounts for about 5 percent of all strokes. Gene and molecular pathological markers to identify persons at risk will hopefully provide interventional tools to both prevent and treat subjects at risk before aneurysmal rupture.
ICH occurs in five brain sites, most commonly in the putamen. With substantial cerebellar ICH in a noncomatose patient, surgical evacuation can be life-saving. The only other site that may benefit from surgery is polar or white matter ICH. In neurologically viable patients, SAH can be treated successfully with surgical extirpation of the aneurysm, or with a variety of endovascular procedures, such as aneurysmal obliteration.
PUBLIC HEALTH IMPORTANCE OF STROKES
As the third leading cause of death and disability, there are important public health implications for strokes, especially since many of the stroke syndromes are preventable. This is particularly true for those due to atherosclerosis, which is the most common cause of strokes. Except for increasing age, all of the risk factors for atherosclerosis
In addition to controlling risk factors, a better understanding of the nature of stroke symptoms by the public is required for expeditious corrective and therapeutic measures, much as has happened with the public's general awareness of chest pain as a symptom of a potential heart attack. Investigations on proteomic and gene expression profiles for strokes to identify individuals at increased risk for strokes will hopefully provide public health planners with an even more powerful tool to intervene effectively for stroke prevention, the ultimate best treatment of strokes.
FRANK YATSU
(SEE ALSO: American Heart Association; Atherosclerosis; Cardiovascular Diseases; Transient Ischemic Attacks)
BIBLIOGRAPHY
Barnett, H. J. M.; Mohr, J. P.; Stein, B.; and Yatsu, F. M., eds. (1998). Stroke: Pathophysiology, Diagnosis & Management. Philadelphia, PA: Churchill-Livingstone.
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Author Info: FRANK YATSU, The Gale Group Inc., Macmillan Reference USA, New York, Gale Encyclopedia of Public Health, 2002 |
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