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acute_ischemic_stroke

Acute ischemic stroke

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

Epidemiology

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

Etiology

The cerebral metabolic rate of oxygen consumption (CMRO2) arises from neurons utilizing energy for two functions:

1) maintenance of cell integrity (homeostasis) which normally accounts for ≈ 40% of energy consumption, and 2) conduction of electrical impulses. The occlusion of an artery produces a central core of ischemic tissue where the CMRO2 is not met. The oxygen deficiency precludes aerobic glycolysis and oxidative phosphorylation. ATP production declines and cell homeostasis cannot be maintained, and within minutes irreversible cell death occurs; a so-called cerebral infarction. Surrounding this central core is the penumbra, where collateral flow (usually through leptomeningeal vessels) provides marginal oxygenation which may impair cellular function without immediate irreversible damage. Cells in the penumbra may remain viable for hours.


Cerebral ischemia due to cerebral vasospasm is a feared complication in patients following aneurysmal subarachnoid hemorrhage (SAH).

see Posttraumatic cerebral infarction.

see Malignant middle cerebral artery infarction.

Brain infarction results from a focal decrease in cerebral blood flow.

A tandem occlusion is an uncommon presentation of acute ischemic stroke that involves occlusion of the extracranial internal carotid artery (EICA) and concomitant occlusion of either the intracranial ICA and/or middle cerebral artery

Clinical Features

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

Diagnosis

Acute ischemic stroke diagnosis.

Differential 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.

Treatment

see Acute ischemic stroke treatment.

Outcome

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

The majority of victims must endure life-long disabilities that not only affect their livelihood, but also have an enormous societal economic impact.

Blood pressure (BP) variability is independently and linearly associated with the development of neurologic deterioration in acute stage of ischemic stroke 1).

For Nozoe et al. no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND 2).

see Cerebral infarction outcome.

Case series

Acute ischemic stroke case series.

Case reports

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 3).

1)
Chung JW, Kim N, Kang J, Park SH, Kim WJ, Ko Y, Park JH, Lee JS, Lee J, Yang MH, Jang MS, Oh CW, Kwon OK, Jung C, Kim BJ, Han MK, Gorelick PB, Bae HJ. Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke. J Hypertens. 2015 Jul 31. [Epub ahead of print] PubMed PMID: 26237556.
2)
Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, Mase K. Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke. Eur Neurol. 2018 Sep 11;80(1-2):50-54. doi: 10.1159/000492794. [Epub ahead of print] PubMed PMID: 30205405.
3)
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.
acute_ischemic_stroke.txt · Last modified: 2020/07/07 10:40 by administrador