Acute cerebral infarction: pathophysiology and modern treatment concepts |
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Authors: | G F Hamann |
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Institution: | Neurologische Klinik, Ludwig-Maximilians-Universit?t, Klinikum Gro?hadern, D-81 377 München, XX
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Abstract: | Summary
This review focuses on the pathophysiological changes in acute cerebral ischemia, with special emphasis on disturbances of
the cerebral blood flow (CBF) and the associated penumbra concept. Alternatively, the model of peri-infarct depolarization
is demonstrated. Metabolic and molecular changes caused by cerebral ischemia and reperfusion are discussed, namely energy
failure, release of glutamate with an excitatoric burst, calcium influx in neurons, generation of free radicals, activation
of different proteases, disturbances of protein synthesis, induction of gene expression and apoptosis, loss of membrane integrity,
edema formation and microvascular disturbances. In summary, the pathophysiological changes after focal cerebral ischemia and
reperfusion are most adequately described by a network of interacting different mechanisms of tissue alterations. The simple
concept of a cascade of ischemic effects which would be easy to block seems to be less applicable. A time window of approximately
6 h for the acute stroke therapy is postulated on the base of the above mentioned pathophysiological changes. The recently
introduced treatment regimen with optimized basic treatment, recanalization using thrombolysis and neuroprotection by different
agents is presented. Different modes of a possible intervention are discussed. Modern concepts of stroke therapy including
stroke-unit care and thrombolysis with add-on neuroprotection seem to have potential for improving the outcome of acute stroke
patients.
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Keywords: | Focal cerebral ischemia • Penumbra • Brain infarction • Thrombolysis • Neuroprotection |
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