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Penumbra stroke

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https://www.readbyqxmd.com/read/29148900/combined-interventional-and-surgical-treatment-of-tandem-middle-cerebral-artery-embolus-and-internal-carotid-artery-occlusion-case-report
#1
Mark B Frenkel, Jaclyn J Renfrow, Jasmeet Singh, Nitin Garg, Stacey Q Wolfe
Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thrombectomy was performed through percutaneous cervical ICA access due to the inability to cross the cervical carotid occlusion. Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasminogen activator (tPA) infusion...
November 17, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29136153/reverse-ncx-attenuates-cellular-sodium-loading-in-metabolically-compromised-cortex
#2
Niklas J Gerkau, Cordula Rakers, Simone Durry, Gabor C Petzold, Christine R Rose
In core regions of ischemic stroke, disruption of blood flow causes breakdown of ionic gradients and, ultimately, calcium overload and cell death. In the surrounding penumbra, cells may recover upon reperfusion, but recovery is hampered by additional metabolic demands imposed by peri-infarct depolarizations (PIDs). There is evidence that sodium influx drives PIDs, but no data exist on PID-related sodium accumulations in vivo. Here, we found that PIDs in mouse neocortex are associated with propagating sodium elevations in neurons and astrocytes...
November 9, 2017: Cerebral Cortex
https://www.readbyqxmd.com/read/29123467/the-role-of-sdf-1-cxcr4-cxcr7-in-neuronal-regeneration-after-cerebral-ischemia
#3
REVIEW
Xi Cheng, Huibin Wang, Xiuchun Zhang, Shanshan Zhao, Zhike Zhou, Xiaopeng Mu, Chuansheng Zhao, Weiyu Teng
Stromal cell-derived factor-1 is a chemoattractant produced by bone marrow stromal cell lines. It is recognized as a critical factor in the immune and central nervous systems (CNSs) as well as exerting a role in cancer. SDF-1 activates two G protein-coupled receptors, CXCR4 and CXCR7; these are expressed in both developing and mature CNSs and participate in multiple physiological and pathological events, e.g., inflammatory response, neurogenesis, angiogenesis, hematopoiesis, cancer metastasis, and HIV infection...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29118797/comparison-of-vacuum-pressures-and-forces-generated-by-different-catheters-and-pumps-for-aspiration-thrombectomy-in-acute-ischemic-stroke
#4
Michael T Froehler
Background: Direct aspiration thrombectomy is an increasingly utilized technique in endovascular stroke treatment that relies on vacuum and suction force to remove the clot. This report assesses the pressures and forces generated by different catheters and pumps. Methods: Vacuum pressures were measured using a vacuum gauge for several catheters (Stryker Catalyst6, Penumbra Ace 064, Medtronic Arc 061, and Penumbra 041) and pumps (Penumbra pump, 60-mL syringe, and the ASPIRE device)...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29101031/a-deficiency-of-the-glun2c-subunit-of-the-n-methyl-d-aspartate-receptor-is-neuroprotective-in-a-mouse-model-of-ischemic-stroke
#5
Adam Holmes, Ning Zhou, Deborah L Donahue, Rashna Balsara, Francis J Castellino
The N-methyl-d-aspartate receptor (NMDAR) ion channel plays a pivotal role in the pathology of ischemic stroke. The functional receptor consists of two GluN1 subunits (a-h) and two GluN2 subunits (A/B/C/D), the expression of which are spatially and temporally regulated in pathological and physiological conditions. While the role of the GluN2A and GluN2B subunit in ischemic stroke has been well developed, the role of the GluN2C subunit in ischemia is not well understood. Following middle carotid artery occlusion (MCAO), GluN2C(-/-) male mice displayed similar volumes of infarct as wild-type (WT) mice...
October 31, 2017: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/29098600/a-model-based-on-the-pennes-bioheat-transfer-equation-is-valid-in-normal-brain-tissue-but-not-brain-tissue-suffering-focal-ischaemia
#6
Thomas Lillicrap, Murat Tahtalı, Andrew Neely, Xiaofei Wang, Andrew Bivard, Christian Lueck
Ischaemic stroke is a major public health issue in both developed and developing nations. Hypothermia is believed to be neuroprotective in cerebral ischaemia. Conversely, elevated brain temperature is associated with poor outcome after ischaemic stroke. Mechanisms of heat exchange in normally-perfused brain are relatively well understood, but these mechanisms have not been studied as extensively during focal cerebral ischaemia. A finite element model (FEM) of heat exchange during focal ischaemia in the human brain was developed, based on the Pennes bioheat equation...
November 2, 2017: Australasian Physical & Engineering Sciences in Medicine
https://www.readbyqxmd.com/read/29060532/mri-based-objective-ischemic-core-penumbra-quantification-in-adult-clinical-stroke
#7
Anusha Vupputuri, Stephen Ashwal, Bryan Tsao, Elia Haddad, Nirmalya Ghosh
Objective and non-invasive quantification of ischemic stroke and differentiation of salvageable from non-salvageable tissue is critical to treatment planning. However current Magnetic Resonance Imaging(MRI) techniques are time consuming and rely on manual detection methods. Computer aided preliminary screening of the injured tissue could assist neuroradiologists in performing more detailed analysis of the lesion components. An established Hierarchical Region Splitting (HRS) method was extended to segment lesions from adult patients who suffered a clinical stroke using diffusion- and perfusion weighted image (DWI-PWI) maps and associated computed maps...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29054448/brain-ischemia-ct-and-mri-techniques-in-acute-ischemic-stroke
#8
REVIEW
Pedro Vilela, Howard A Rowley
Imaging plays a central role for intravenous and intra-arterial arterial ischemic stroke treatment patient selection. Computed tomography (CT) / CT angiography or magnetic resonance (MR) / MR angiography imaging are used to exclude stroke mimics and haemorrhage, to determine the cause and mechanism of stroke, to define the extension of brain infarct and to identify the arterial occlusion. Imaging may identify the patients that will be benefit more from revascularization therapies independently of the conventional therapeutic time window allowing individualized treatment decisions and improving individual patient outcome...
August 24, 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/29052571/susceptibility-weighted-imaging-in-thrombolytic-therapy-of-acute-ischemic-stroke
#9
REVIEW
Lin Li, Ming-Su Liu, Guang-Qin Li, Yang Zheng, Tong-Li Guo, Xin Kang, Mao-Ting Yuan
OBJECTIVE: To provide a comprehensive and latest overview of susceptibility-weighted imaging (SWI) in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. DATA SOURCES: Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2*, thrombolysis, recombinant tissue plasminogen activator (rt-PA), thrombolytic therapy, and stroke...
October 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/29037436/which-imaging-before-reperfusion-strategy
#10
REVIEW
J M Olivot
The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29034608/nanoparticle-based-therapeutics-for-brain-injury
#11
REVIEW
Vimala N Bharadwaj, Duong T Nguyen, Vikram D Kodibagkar, Sarah E Stabenfeldt
Brain injuries affect a large patient population with major physical and emotional suffering for patients and their relatives; at a significant cost to the society. Effective diagnostic and therapeutic options available for brain injuries are limited by the complex brain injury pathology involving blood-brain barrier (BBB). Brain injuries, including ischemic stroke and brain trauma, initiate BBB opening for a short period of time, which is followed by a second reopening for an extended time. The leaky BBB and/or the alterations in the receptor expression on BBB may provide opportunities for therapeutic delivery via nanoparticles (NPs)...
October 16, 2017: Advanced Healthcare Materials
https://www.readbyqxmd.com/read/29018134/neuronal-sirt1-silent-information-regulator-2-homologue-1-regulates-glycolysis-and-mediates-resveratrol-induced-ischemic-tolerance
#12
Kevin B Koronowski, Nathalie Khoury, Isabel Saul, Zachary B Loris, Charles H Cohan, Holly M Stradecki-Cohan, Kunjan R Dave, Juan I Young, Miguel A Perez-Pinzon
BACKGROUND AND PURPOSE: Resveratrol, at least in part via SIRT1 (silent information regulator 2 homologue 1) activation, protects against cerebral ischemia when administered 2 days before injury. However, it remains unclear if SIRT1 activation must occur, and in which brain cell types, for the induction of neuroprotection. We hypothesized that neuronal SIRT1 is essential for resveratrol-induced ischemic tolerance and sought to characterize the metabolic pathways regulated by neuronal Sirt1 at the cellular level in the brain...
November 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28987436/ischemic-stroke-advances-in-diagnosis-and-management
#13
REVIEW
Courtney R Cassella, Andy Jagoda
Acute ischemic stroke carries the risk of morbidity and mortality. Since the advent of intravenous thrombolysis, there have been improvements in stroke care and functional outcomes. Studies of populations once excluded from thrombolysis have begun to elucidate candidates who might benefit and thus should be engaged in the process of shared decision-making. Imaging is evolving to better target the ischemic penumbra salvageable with prompt reperfusion. Availability and use of computed tomography angiography identifies large-vessel occlusions, and new-generation endovascular therapy devices are improving outcomes in these patients...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28983488/neurovascular-function-recovery-after-focal-ischemic-stroke-by-enhancing-cerebral-collateral-circulation-via-peripheral-stimulation-mediated-interarterial-anastomosis
#14
Han-Chi Pan, Lun-De Liao, Yu-Chun Lo, Jia-Wei Chen, Han-Lin Wang, Li Yang, Yao-Wen Liang, Po-Yu Huang, Ming-Hsun Yang, You-Yin Chen
Current treatments for ischemic stroke have focused on the administration of a tissue plasminogen activator, although the associated side effects and subsequent reperfusion injury remain challenging. Peripheral electrical stimulation has shed light on therapeutic interventions for ischemia by increasing cerebral blood flow (CBF) to the target region through collateral circulation, although the mechanism remains elusive. Here, a focal photothrombotic ischemic (PTI) stroke was induced in the right hemispheric primary somatosensory forelimb cortex (S1FL) of rat brains, and the therapeutic effects of forelimb and hindlimb stimulation were characterized at the contralesional S1FL...
July 2017: Neurophotonics
https://www.readbyqxmd.com/read/28982332/asymmetric-cerebrovascular-collateral-supply-affects-cognition-in-patients-with-unilateral-carotid-artery-stenosis
#15
Kuo-Lun Huang, Ting-Yu Chang, Chien-Hung Chang, Ho-Ling Liu, Yeu-Jhy Chang, Chi-Hung Liu, Ho-Fai Wong, Yi-Ming Wu, Tsong-Hai Lee, Meng-Yang Ho
BACKGROUND: The time to maximum of the residue function (TMax) has been employed to identify the penumbra in acute ischemic stroke. Cognitive impairment in patients with carotid artery stenosis (CAS) has been attributed to chronic cerebral hypoperfusion. The study aimed to examine whether cognitive impairment can be detected based on a preliminary TMax cutoff in patients with unilateral CAS. METHODS: Fifty unilateral CAS patients underwent dynamic susceptibility contrast MR perfusion...
October 5, 2017: Current Neurovascular Research
https://www.readbyqxmd.com/read/28982330/potential-biomarkers-with-plasma-cortisol-brain-derived-neurotrophic-factor-and-nitrites-in-patients-with-acute-ischemic-stroke
#16
S Casas, A F Perez, M Mattiazzi, J Lopez, A Folgueira, G M Gargiulo-Monachelli, M C Gonzalez Deniselle, A F De Nicola
BACKGROUND: Acute ischemic stroke (AIS) represents an economic challenge for health systems all over the globe. Changes of neuroactive steroids have been found in different neurological diseases. We have previously demonstrated that old patients with AIS show changes of plasma cortisol and estradiol concentrations, in that increased steroid levels are associated with a deterioration of neurological status and a worse cognitive decline. OBJECTIVE: The present study assessed in patients with AIS if changes of behavior, brain-derived neurotrophic factor (BDNF) and nitrites (NO-2) bear a relationship with the degree of hypercortisolism...
October 5, 2017: Current Neurovascular Research
https://www.readbyqxmd.com/read/28974996/monitoring-pressure-augmentation-in-patients-with-ischemic-penumbra-using-continuous-electroencephalogram-three-cases-and-a-review-of-the-literature
#17
Christopher R Newey, Vikas Gupta, Agnieszka A Ardelt
BACKGROUND: Continuous electroencephalography (CEEG) is a sensitive, noninvasive surrogate monitor of cerebral blood flow (CBF). Changes in CBF can be seen as changes in the frequencies on the CEEG. This case series suggests that increase in CEEG frequencies may be used to detect improved CBF following pressure augmentation such as with treatment of vasospasm from subarachnoid hemorrhage (SAH) or acute thrombosis from ischemic stroke. The application of this observation to clinical decision-making has not been clearly defined and requires further study...
October 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28965105/incorporation-of-relative-cerebral-blood-flow-into-ct-perfusion-maps-reduces-false-at-risk-penumbra
#18
Shlomi Peretz, David Orion, David Last, Yael Mardor, Yotam Kimmel, Shelly Yehezkely, Eyal Lotan, Ze'ev Itsekson-Hayosh, Sylvia Koton, David Guez, David Tanne
PURPOSE: The region defined as 'at risk' penumbra by current CT perfusion (CTP) maps is largely overestimated. We aimed to quantitate the portion of true 'at risk' tissue within CTP penumbra and to determine the parameter and threshold that would optimally distinguish it from false 'at risk' tissue, that is, benign oligaemia. METHODS: Among acute stroke patients evaluated by multimodal CT (NCCT/CTA/CTP) we identified those that had not undergone endovascular/thrombolytic treatment and had follow-up NCCT...
September 30, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28963051/-phenserine-inhibits-neuronal-apoptosis-following-ischemia-reperfusion-injury
#19
Cheng-Fu Chang, Jing-Huei Lai, John Chung-Che Wu, Nigel H Greig, Robert E Becker, Yu Luo, Yen-Hua Chen, Shuo-Jhen Kang, Yung-Hsiao Chiang, Kai-Yun Chen
Stroke commonly leads to adult disability and death worldwide. Its major symptoms are spastic hemiplegia and discordant motion, consequent to neuronal cell death induced by brain vessel occlusion. Acetylcholinesterase (AChE) is upregulated and allied with inflammation and apoptosis after stroke. Recent studies suggest that AChE inhibition ameliorates ischemia-reperfusion injury and has neuroprotective properties. (-)-Phenserine, a reversible AChE inhibitor, has a broad range of actions independent of its AChE properties, including neuroprotective ones...
December 15, 2017: Brain Research
https://www.readbyqxmd.com/read/28959484/determinants-of-the-impact-of-blood-pressure-variability-on-neurological-outcome-after-acute-ischaemic-stroke
#20
Adam de Havenon, Alicia Bennett, Gregory J Stoddard, Gordon Smith, Lee Chung, Steve O'Donnell, J Scott McNally, David Tirschwell, Jennifer J Majersik
INTRODUCTION: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. METHODS: We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (mRS) 30-365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission...
March 2017: Stroke and Vascular Neurology
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