Preface

Stroke is among the leading causes of morbidity and mortality globally and its incidence is on the rise. It is increasingly recognized that an understanding of various clinical presentations among clinicians and other stakeholders is extremely important to achieve better outcomes in stroke patients. Apart from the obvious clinical deficits, the subtle signs and clinical symptoms of stroke, including acute dizziness and vertigo, may provide a clue about ischemic events involving the brain. Because of the subtlety of stroke's clinical presentation, it is challenging to diagnose in clinics as well as in emergency departments. This book provides a practical approach and a summary of recommendations for the management of stroke patients. A detailed history and clinical examinations are the mainstays of stroke diagnosis followed by a CT scan, which is the initial investigation of choice in most settings. CT can be followed by MRI, particularly diffusion-weighted (DWI) sequences and other investigations, to assess the cerebral cranial vasculature and formulate a management strategy. Overall, the diagnosis and management of stroke require multimodal strategies and a multidisciplinary approach to make the diagnosis and deliver optimal treatment, which will include medical as well as surgical management in select cases. The book helps to understand and explore current advances, including the identification of the molecular characteristics that determine the malignant phenotype that may further help to develop effective management strategies, including immunotherapy. There is a scope for future research where global leaders can come together to develop affordable, sustainable, and uniformly available options to prevent as well as manage stroke.

> **Amit Agrawal** Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India

**1**

**3. Diagnosis**

**Chapter 1**

*and Amit Agrawal*

**2. Clinical characteristics**

**1. Introduction**

Introductory Chapter:

Intracerebral Hemorrhage

*Luis Rafael Moscote-Salazar, Md. Moshiur Rahman* 

these are special subtypes have relative better clinical outcome [2].

systemic arterial hypertension and cerebral amyloid angiopathy [9, 10].

Primary spontaneous intracerebral haemorrhage (SICH) can lead to fatal outcomes and in survivors can be cause of significant morbidity and long-term disability [1]. In up to 90% patient's arterial hypertension or amyloid angiopathy gas been attributed as the cause of bleeding [2]. Important points to differentiate primary SICH from secondary SICH include primary SICH usually involve basal ganglia, thalamus in patients with history of hypertension [2–5]. The increase in life expectancy and increase in aging population it can be anticipated the burden of SICH shall continue to increase [6, 7] with an increase in overall lifetime cost for management of these patients [8]. The role of neurosurgical intervention and available options in the management of spontaneous SICH is not only increasing but also able to improve overall outcomes. We exclude the discussion for the management of spontaneous cerebellar hematomas as

Each patient needs to evaluated in details including details clinical history and clinical examination particularly neurological deficits and extent of the deficits [2]. Clinical characteristics of the SICH depends on the size, location of the bleed presence or absence of hydrocephalus. General manifestations include sign of raised intracranial pressure i.e., headache, vomiting, seizures, and altered levels of consciousness (including coma in severe cases) [2]. The two common risk factors for SICH include

Primary SICH needs to be differentiated from other causes of haemorrhages i.e., from secondary SICH (for example traumatic ICH, tumours with haemorrhage, vascular malformations, and pharmacological causes of SICH) [2]. Whenever a SICH is suspected, CT scan brain will provide the details regarding presence of blood including its location with sensitivity of more than 95%, in some patients [11, 12] CT scan

Neurosurgical Management of

## **Chapter 1**
