Brain Haemorrhage AK Mahapatra, PS Chandra, Raj Kumar
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1BRAIN HAEMORRHAGE2
3BRAIN HAEMORRHAGE
AK Mahapatra MS MCh DNB MAMS Director Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, UP, India PS Chandra MCh Associate Professor Department of Neurosurgery AIIMS, New Delhi, India Raj Kumar MS MCh MAMS MNASc Professor and Head Department of Neurosurgery SGPGIMS, Lucknow, UP, India
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© 2007, Jaypee Brothers Medical Publishers
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First Edition: 2007
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6
7CONTRIBUTORS
8
9FOREWORD
It gives me a great pleasure for writing the foreword for this book. ‘Brain attack’ or Spontaneous Intracerebral Heamorrhage (SICH) is not very different from ‘heart attack’ though it is much less commonly recognised and treated despite the fact that it is almost equally common in incidence and prevalence. It is characterised by formation of a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10–15% of all strokes and is associated with a higher mortality rate than either ischaemic stroke or subarachnoid haemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumours, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. To date ten prospective randomised controlled studies have been conducted to compare surgical and medical management of SICH, the last being the Surgical trial for Intracerebral Haematomas (STICH) trial which has been a landmark study for this pathology. Although definitive evidence favouring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. However, prevention of this problem, by treating adequately, conditions like hypertension, diabetes, hyperlipidemias etc. would be the most important solution to reduce the global burden of this problem; the same factors which are also responsible for ‘heart attack’.
This book provides a ‘bird's eye view’ of this subject, and provides a well structured and a rational approach to this problem. The chapters have been written in simple language and every chapter is small in size, allowing the reader to have a quick, yet a comprehensive grasp of the Subject. The target audience for this book would be practicing physicians, medical and postgraduate students, neurologists and neurosurgeons. This monumental work would be of great benefit for the common medical practitioner who normally has little idea about this problem, keeping in mind the extrapolative figures predicted by the WHO, that by 2020, India would have a huge number of these cases due to factors like increasing population, hypertension, diabetes, etc.
I would like to congratulate the authors for their commendable efforts. The book, while mostly complete for the purpose it was designed, is more heavily oriented for the clinician. I hope that in future editions the authors would add more topics on pathogenesis, aetiogenic mechanisms and radiology. I further hope that they continue in this endeavour and continue bringing out future editions.
Prof P Venugopal
Director
AIIMS
New Delhi, India
10
11PREFACE
Intracerebral Haemorrhage (ICH) is a serious cerebrovascular event with very adverse ramifications. It is a sudden catastrophic event, not very much unlike ‘heart attack’ and the term ‘brain attack’ may not be inappropriate to describe it.
Patients with ICH typically present with sudden onset of severe headache, vomiting, depressed consciousness, and focal neurologic signs. Although most cases of ICH have been attributed to hypertension, there is an increasing number of cases in patients for whom there has not been a diagnosis of hypertension. ICH in these patients may be associated with non-hypertensive mechanisms that include aneurysms, tumour, vascular malformation, vasculopathies, and disorders of coagulation.
ICH is likely to assume an epidemic proportion due to significant lifestyle change e.g., more hours of work, increase in incidence of hypertension, increased consumption of fatty foods, etc. It is not surprising that there will be a rise of ICH as the same risk factors are responsible for the ‘heart attack’.
Furthermore, in the recent decades there has been a significant change in the management of this condition with vast improvements occurring in technology, particularly in imaging of brain and refinements in neurosurgical techniques. Keeping this in mind, the book has been written for the primary physicians who generally have little idea of this condition. However, it would be beneficial to medical students, internists, neurologists and neurosurgeons. The language thus has been kept very simple and every chapter is limited to only a few pages so that the topic may be covered quickly and comprehensively.
We sincerely hope that this book will be found useful to the readers intended. We would be grateful to our readers for their valued suggestions which may be used for improvement in future publications.
AK Mahapatra
PS Chandra
Raj Kumar