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This 52-year-old right-handed female presented with a 10-year history of cognitive decline, heralded by difficulty concentrating, along with mild depression and anxiety. Despite improvement of her mood with antidepressant medication, her ability to focus continued to deteriorate. Within a few years, she exhibited difficulty with multitasking, affecting her performance at work as a petrographer. She could still manage her basic activities of daily living, but they demanded more effort than before. Relevant medical history included migraines with aura and hypertension, which had been under good control for the past eight years. She was taking bupropion 450 mg and amlodipine 5 mg daily. Her family history was relevant for stroke in her mother in fifties and migraine in her mother and sister. The neurological examination was remarkable for brisk reflexes and difficulties with tandem gait. Neuropsychological evaluation revealed impairment of executive abilities, including processing speed, task switching and working memory, as well as impairments in memory encoding and retrieval. Brain MRI showed extensive, symmetric, white matter changes (Figure 41.1).
Now in its third edition, this essential and detailed guide provides wide-ranging support for those diagnosing, treating and assessing complex types of cerebrovascular diseases, in a high pressure, time-constrained environment. Authored by leading clinicians in the field of neurology, and supported by advanced in brain-mapping technologies, this cutting-edge manual provides physicians, neurologists and emergency practitioners at all levels with a vital commentary on those relatively uncommon types of cerebrovascular disease that can lead to patients suffering a stroke. This new edition offers chapter-by-chapter imaging findings, evaluation and management advice, alongside insights into new topics such as CARASIL, sickle cell disease, radiation-induced cerebrovascular disease and blue rubber bleb syndrome. Updated and thorough, the guide provides a clear presentation on the nature, diagnosis, and treatment of everyday symptoms, through to more specialised cases. Building upon existing experience, practitioners can confidently assess patient needs, and correctly diagnose symptoms first time.