Book contents
- Frontmatter
- Contents
- Introduction
- PART I INTELLECTUAL FOUNDATION OF PSYCHIATRY
- PART II EVALUATION AND MEASUREMENT
- PART III PSYCHIATRIC DISORDERS
- PART IV PSYCHIATRIC THERAPEUTICS
- PART V NEUROPSYCHIATRY AND RELEVANT NEUROLOGIC CONDITIONS
- 37 Congenital Neuropsychiatric Disorders
- 38 Infections of the Nervous System
- 39 Seizure Disorders
- 40 Strokes and Transient Ischemic Attacks
- 41 Brain Tumors and Injuries
- 42 Headache
- 43 Spinal Cord Anatomy and Related Conditions
- 44 Movement Disorders
- 45 Language Impairment
- 46 Neuromuscular Disorders and Peripheral Nerve Disorders
- PART VI SPECIAL TOPICS
- PART VII REVIEW QUESTIONS
- Bibliography
- Index
40 - Strokes and Transient Ischemic Attacks
from PART V - NEUROPSYCHIATRY AND RELEVANT NEUROLOGIC CONDITIONS
Published online by Cambridge University Press: 18 January 2010
- Frontmatter
- Contents
- Introduction
- PART I INTELLECTUAL FOUNDATION OF PSYCHIATRY
- PART II EVALUATION AND MEASUREMENT
- PART III PSYCHIATRIC DISORDERS
- PART IV PSYCHIATRIC THERAPEUTICS
- PART V NEUROPSYCHIATRY AND RELEVANT NEUROLOGIC CONDITIONS
- 37 Congenital Neuropsychiatric Disorders
- 38 Infections of the Nervous System
- 39 Seizure Disorders
- 40 Strokes and Transient Ischemic Attacks
- 41 Brain Tumors and Injuries
- 42 Headache
- 43 Spinal Cord Anatomy and Related Conditions
- 44 Movement Disorders
- 45 Language Impairment
- 46 Neuromuscular Disorders and Peripheral Nerve Disorders
- PART VI SPECIAL TOPICS
- PART VII REVIEW QUESTIONS
- Bibliography
- Index
Summary
Cerebrovascular disease is one of the major causes of disability and death.
The primary risk factor is hypertension. The process of pathology starts from the sustained high blood pressure that damages the lining epithelium and exposes the underlying collagen. Platelets then aggregate at the damaged spot to start the process of repairing. Imperfect repair makes the site more vulnerable and inviting to new damage and new repair. Repeated damages and repairs change the architecture of the vessels and make them narrow, stiff, deformed, and uneven. These pathological changes cause double jeopardy – the abnormal cranial vascular system causes regional blood pressure fluctuation, and the vessels are vulnerable to blood pressure fluctuation. Episodes of lower blood pressure superimposed on already narrowed lumen may cause ischemic events, while episodes of higher blood pressure may tear apart the vessel wall and cause hemorrhagic strokes. Therefore, aggressive control of blood pressure is the single most important preventative measure for cerebrovascular accidents (CVAs).
Other conditions cause strokes and transient ischemic attacks (TIAs) include inflammatory disorders, cardiac arrhythmias, cardiac valve conditions, rheumatic heart disease, sickle cell disease, polycythemia, and hypercoagulable states.
Patients with cerebrovascular disorders were found to have higher rates of depression. Vascular dementia and disturbance in impulse control also call for psychiatric involvement. Another prominent psychiatric concern is drug interactions between psychotropics and other medicines, particularly with anticoagulants.
Anosognosia
▶ Unawareness of existing condition, e.g., a hemiplegic patient believes he has no problem in walking
▶ Appears following stroke or other brain injury, and usually resolves in weeks
▶ The term is also used to describe psychiatric patients without insight
- Type
- Chapter
- Information
- Comprehensive Psychiatry Review , pp. 304 - 311Publisher: Cambridge University PressPrint publication year: 2009