User Tools

Site Tools


ischemic_stroke

Ischemic stroke

After subarachnoid hemorrhage delayed onset vasospasm can result in devastating ischemic stroke.

Ischemia results if blood flow to the brain is below 18 to 20 ml per 100 g per minute, and tissue death occurs if flow dips below 8 to 10 ml per 100 g per minute.

Epidemiology

Ischemic stroke is a leading cause of mortality and morbidity worldwide, and atherosclerosis is one of the major risk factors for this neurologic deficit.

Classification

Etiology

The etiological origins of ischemic stroke and resulting pathological processes are mediated by a multifaceted cascade of molecular mechanisms that are in part modulated by posttranscriptional activity. Accumulating evidence has revealed a role for microRNAs (miRNAs) as essential mediators of posttranscriptional gene silencing in both the physiology of brain development and pathology of ischemic stroke.

In a review, Li et al. compile miRNAs that have been reported to regulate various stroke risk factors and pre-disease mechanisms, including hypertension, atherosclerosis, and diabetes, followed by an in-depth analysis of miRNAs in ischemic stroke pathogenesis, such as excitotoxicity, oxidative stress, inflammation, apoptosis, angiogenesis and neurogenesis. Since promoting or suppressing expression of miRNAs by specific pharmaceutical and non-pharmaceutical therapies may be beneficial to post-stroke recovery, they also highlight the potential therapeutic value of miRNAs in clinical settings 1).


Ischemic complications during intracranial aneurysm surgery are a frequent cause of postoperative infarctions and new neurological deficits.

Although the beach chair position (BCP) is widely used during shoulder surgery, it has been reported to associate with a reduction in cerebral blood flow, oxygenation, and risk of cerebral ischemia.


Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly.

Atherosclerotic disease of the carotid artery has a high prevalence in patients aged over 50 and is a major cause of ischemic stroke.

Not less than 50% of all ischemic strokes appear to occur resulting from pathology of extracranial arteries. Occlusions and stenoses are more commonly encountered in carotid arteries, with the incidence of occlusion of the internal carotid artery (ICA) ranging from 5 to 10% within the structure of all lesions of brachiocephalic artery (BCA).


CD137 gene is associated with risk of ischemic stroke in the northern Han Chinese. Moreover, CD137 gene polymorphism may be one mediating factor between diabetes and ischemic stroke 2).


Secondary ischemic injury is common after acute brain injury and can be evaluated with the use of neuromonitoring devices.

Cerebral venous sinus thrombosis (CVT) is a rare cerebrovascular accident.


Impaired collateral blood flow through the circle of Willis is a recognized risk factor for ischemic stroke.

Pathophysiology

In brain tissue, a biochemical cascade known as the ischemic cascade is triggered when the tissue becomes ischemic, potentially resulting in damage to and death of brain cells.

Complications

Outcome

Ischemic stroke is a major cause of death and long-term disability worldwide.

Books

Ischemic Stroke (Emergency Management in Neurology) By Giuseppe D'Aliberti, Marco Longoni, Valentina Oppo, Valentina Perini, Luca Valvassori, Simone Vidale, Cristina Motto

1)
Li G, Morris-Blanco KC, Lopez MS, Yang T, Zhao H, Vemuganti R, Luo Y. Impact of microRNAs on ischemic stroke: From pre- to post-disease. Prog Neurobiol. 2017 Aug 22. pii: S0301-0082(17)30033-3. doi: 10.1016/j.pneurobio.2017.08.002. [Epub ahead of print] Review. PubMed PMID: 28842356.
2)
Zhang S, Li Z, Zhang R, Li X, Zheng H, Ma Q, Zhang H, Hou W, Zhang F, Wu Y, Sun L, Tian J. Novel CD137 Gene Polymorphisms and Susceptibility to Ischemic Stroke in the Northern Chinese Han Population. Neuromolecular Med. 2017 Jul 28. doi: 10.1007/s12017-017-8457-7. [Epub ahead of print] PubMed PMID: 28755037.
ischemic_stroke.txt · Last modified: 2018/10/22 18:00 by administrador