Acute ischemic stroke

Acute ischemic stroke (AIS) AKA cerebral infarction. Obsolete term: cerebrovascular accident (CVA).

see Delayed cerebral ischemia.

Endovascular therapy (ET) is typically not considered for patients with large baseline ischemic cores (irreversibly injured tissue). Computed tomographic perfusion (CTP) imaging may identify a subset of patients with large ischemic cores who remain at risk for significant infarct expansion and thus could still benefit from reperfusion to reduce their degree of disability 1).

Is thought to play a role in a number of neuropathic pain conditions, and yet the role of hypoxia has also not been characterized in neuropathic pain conditions.

see Cerebral ischemia pathophysiology.

Raabe and Seidel, discuss imaging and neurophysiological tools that may help the surgeon to detect intraoperative ischemia. The strength of intraoperative digital subtraction angiography (DSA) is the full view of the arterial and venous vessel. DSA is the gold standard in complex and giant aneurysms, but due to certain disadvantages, it cannot be considered standard of care.

Intraoperative microvascular Doppler sonography is probably the fastest diagnostic tool and can quickly aid diagnosis of large vessel occlusions.

Intraoperative indocyanine green videoangiography is the best tool to assess flow in perforating and larger arteries, as well as occlusion of the aneurysm sac.

Intraoperative neurophysiological monitoring with somatosensory evoked potentials and motor evoked potentials indirectly measures blood flow by recording neuronal function. It covers all causes of intraoperative ischemia, provided that ischemia occurs in the brain areas under surveillance. However, every method has advantages and disadvantages. No single method is superior to the others in every aspect. Therefore, it is very important for the neurosurgeon to know the strengths and weaknesses of each tool in order to have them available, to know how to use them for each individual situation, and to be ready to apply them within the time window for reversible cerebral ischemia 2).

During cerebral ischemia induced by severe hemorrhagic shock, intravascular microdialysis of the draining venous blood will exhibit changes of the Lactate to Pyruvate Ratio (LP ratio) revealing the deterioration of global cerebral oxidative energy metabolism. In neurocritical care, this technique might be used to give information regarding global cerebral energy metabolism in addition to the regional information obtained from intracerebral microdialysis catheters. The technique might also be used to evaluate cerebral energy state in various critical care conditions when insertion of an intracerebral microdialysis catheter may be contraindicated, e.g., resuscitation after cardiac standstill, open-heart surgery, and multi-trauma 3).

see Cerebral ischemia treatment.

Of the approximately 795 000 strokes in the United States annually, 87% are from ischemia and result in significant morbidity and mortality.

Acute ischemic stroke in COVID-19 pandemic

Acute ischemic stroke Etiology

Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke.

Acute ischemic stroke diagnosis.

A cerebral infarction is a type of ischemic stroke resulting from a blockage in the blood vessels supplying blood to the brain. It can be atherothrombotic or embolic.

Stroke caused by cerebral infarction should be distinguished from two other kinds of stroke: cerebral hemorrhage and subarachnoid hemorrhage.

A cerebral infarction occurs when a blood vessel that supplies a part of the brain becomes blocked or leakage occurs outside the vessel walls. This loss of blood supply results in the death of that area of tissue. Cerebral infarctions vary in their severity with one third of the cases resulting in death.

see Acute ischemic stroke treatment.

Acute ischemic stroke outcome.

Acute ischemic stroke case series.

A 70-year-old man was admitted to the hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem occlusion in the left carotid artery with a left M1 occlusion. Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.

Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path 4).

Rebello LC, Bouslama M, Haussen DC, Dehkharghani S, Grossberg JA, Belagaje S, Frankel MR, Nogueira RG. Endovascular Treatment for Patients With Acute Stroke Who Have a Large Ischemic Core and Large Mismatch Imaging Profile. JAMA Neurol. 2016 Nov 7. doi: 10.1001/jamaneurol.2016.3954. [Epub ahead of print] PubMed PMID: 27820620.
Raabe A, Seidel K. Prevention of ischemic complications during aneurysm surgery. J Neurosurg Sci. 2015 Nov 24. [Epub ahead of print] PubMed PMID: 26606432.
Jakobsen R, Halfeld Nielsen T, Granfeldt A, Toft P, Nordström CH. A technique for continuous bedside monitoring of global cerebral energy state. Intensive Care Med Exp. 2016 Dec;4(1):3. doi: 10.1186/s40635-016-0077-2. Epub 2016 Jan 20. PubMed PMID: 26791144.
Zhang M, Hao JH, Lin K, Cui QK, Zhang LY. Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report. World J Clin Cases. 2020 Feb 6;8(3):630-637. doi: 10.12998/wjcc.v8.i3.630. PubMed PMID: 32110676; PubMed Central PMCID: PMC7031835.
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