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Penumbra stroke

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https://www.readbyqxmd.com/read/29777362/the-silver-effect-of-admission-glucose-level-on-excellent-outcome-in-thrombolysed-stroke-patients
#1
Charlotte Rosso, Flore Baronnet, Belen Diaz, Raphael Le Bouc, Giulia Frasca Polara, Eric Jr Moulton, Sandrine Deltour, Anne Leger, Sophie Crozier, Yves Samson
Higher admission glucose levels (AGL) are associated with less favorable outcome in thrombolysis. But, could AGL's impact on outcome vary by onset-to-treatment (OTT) time? Is hyperglycemia associated with a shorter therapeutic time window for excellent outcome for thrombolysed stroke patients? We assessed predictive values of AGL, baseline NIHSS, age, and OTT time quartiles on excellent outcome (3-month modified Rankin score of 0-1) in 773 patients treated by rt-Pa. We added the AGL × OTT time quartile interaction in the model and separately analyzed the predictive values of AGL, age, and NIHSS for each OTT time quartile if the interaction was significant...
May 18, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29769288/targeted-complement-inhibition-salvages-stressed-neurons-and-inhibits-neuroinflammation-after-stroke-in-mice
#2
Ali Alawieh, E Farris Langley, Stephen Tomlinson
Ischemic stroke results from the interruption of blood flow to the brain resulting in long-term motor and cognitive neurological deficits, and it is a leading cause of death and disability. Current interventions focus on the restoration of blood flow to limit neuronal death, but these treatments have a therapeutic window of only a few hours and do not address post-stroke cerebral inflammation. The complement system, a component of the innate immune system, is activated by natural immunoglobulin M (IgM) antibodies that recognize neoepitopes expressed in the brain after ischemic stroke...
May 16, 2018: Science Translational Medicine
https://www.readbyqxmd.com/read/29765502/the-phenolic-components-of-gastrodia-elata-improve-prognosis-in-rats-after-cerebral-ischemia-reperfusion-by-enhancing-the-endogenous-antioxidant-mechanisms
#3
Anhuan Shi, Jianming Xiang, Fangyan He, Yanping Zhu, Gongbei Zhu, Yuhan Lin, Ningna Zhou
Pharmacological or spontaneous thrombolysis in ischemic stroke triggers an outbreak of reactive oxygen species and results in neuron death. Nrf2-mediated antioxidation in cells has been proved as a pivotal target for neuroprotection. This research reports that phenolic components of Gastrodia elata Blume (PCGE), a traditional Chinese medicine, can alleviate the pathological lesions in the penumbra and hippocampus by increasing the survival of neurons and astrocytes and improve neurofunction and cognition after reperfusion in a rat model of middle cerebral artery occlusion...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29746644/relationships-between-selective-neuronal-loss-and-microglial-activation-after-ischaemic-stroke-in-man
#4
Rhiannon S Morris, P Simon Jones, Josef A Alawneh, Young T Hong, Tim D Fryer, Franklin I Aigbirhio, Elizabeth A Warburton, Jean-Claude Baron
Modern ischaemic stroke management involves intravenous thrombolysis followed by mechanical thrombectomy, which allows markedly higher rates of recanalization and penumbral salvage than thrombolysis alone. However, <50% of treated patients eventually enjoy independent life. It is therefore important to identify complementary therapeutic targets. In rodent models, the salvaged penumbra is consistently affected by selective neuronal loss, which may hinder recovery by interfering with plastic processes, as well as by microglial activation, which may exacerbate neuronal death...
May 9, 2018: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29734653/the-janus-face-of-vegf-in-stroke
#5
REVIEW
Samuel J Geiseler, Cecilie Morland
The family of vascular endothelial growth factors (VEGFs) are known for their regulation of vascularization. In the brain, VEGFs are important regulators of angiogenesis, neuroprotection and neurogenesis. Dysregulation of VEGFs is involved in a large number of neurodegenerative diseases and acute neurological insults, including stroke. Stroke is the main cause of acquired disabilities, and normally results from an occlusion of a cerebral artery or a hemorrhage, both leading to focal ischemia. Neurons in the ischemic core rapidly undergo necrosis...
May 4, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29728011/the-protective-roles-of-l-borneolum-d-borneolum-and-synthetic-borneol-in-cerebral-ischaemia-via-modulation-of-the-neurovascular-unit
#6
Taiwei Dong, Nian Chen, Xiao Ma, Jian Wang, Jing Wen, Qian Xie, Rong Ma
OBJECTIVE: Borneol has been used to treat stroke in China since ancient times. In our previous research, we demonstrated the effect of borneol on cerebral ischaemia injury via meta-analysis. The neurovascular unit (NVU) is the structural basis of the preservation of the brain microenvironment and is believed to be a promising target in treating stroke. In this research, we explored the roles of three kinds of borneol, namely, L-borneolum (B1), D-borneolum (B2) and synthetic borneol (B3), in the NVU with permanent middle cerebral artery occluded (pMCAO) rats...
June 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29719555/a-review-of-pre-intervention-prognostic-scores-for-early-prognostication-and-patient-selection-in-endovascular-management-of-large-vessel-occlusion-stroke
#7
REVIEW
Syed Ali Raza, Srikant Rangaraju
Background: Endovascular therapy (ET) has emerged as a highly effective treatment for acute large vessel occlusion stroke (LVOS). Tools that facilitate optimal patient selection of patients for ET are needed in order to maximize therapeutic benefit in a cost-effective manner. Several pre-intervention prognostic scores for prediction of outcomes in LVOS patients and patient selection for ET have been developed and validated, but their clinical use has been limited. Here, we review existing pre-intervention prognostic scores, compare their prognostic accuracies and levels of validation and identify gaps in current knowledge...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29692708/paradigm-shift-to-neuroimmunomodulation-for-translational-neuroprotection-in-stroke
#8
REVIEW
Diana Amantea, Rosaria Greco, Giuseppe Micieli, Giacinto Bagetta
The treatment of acute ischemic stroke is still an unresolved clinical problem since the only approved therapeutic intervention relies on early blood flow restoration through pharmacological thrombolysis, mechanical thrombus removal, or a combination of both strategies. Due to their numerous complications and to the narrow time-window for the intervention, only a minority of stroke patients can actually benefit from revascularization procedures, highlighting the urgent need of identifying novel strategies to prevent the progression of an irreversible damage in the ischemic penumbra...
2018: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29688134/genistein-attenuates-brain-damage-induced-by-transient-cerebral-ischemia-through-up-regulation-of-nrf2-expression-in-ovariectomized-rats
#9
Zhong-Yan Miao, Xu Xia, Lu Che, Yan-Tao Song
OBJECTIVE: Postmenopausal women possess higher incidence of stroke and worse prognosis. Although estrogen replacement therapy has obvious neuroprotective effects against stroke, it is always accompanied with several adverse effects and undesired outcomes. Genistein, a natural phytoestrogen, has been indicated to be a potential neuroprotective alternative for postmenopausal women against stroke. However, the role and mechanism of genistein's neuroprotective effects against stroke in ovariectomized rats have rarely been explored...
April 24, 2018: Neurological Research
https://www.readbyqxmd.com/read/29682700/therapeutic-potential-of-a-combination-of-electroacupuncture-and-trkb-expressing-mesenchymal-stem-cells-for-ischemic-stroke
#10
Sung Min Ahn, Yu Ri Kim, Yong-Il Shin, Ki Tae Ha, Seo-Yeon Lee, Hwa Kyoung Shin, Byung Tae Choi
We prepared and grafted tropomyosin receptor kinase B (TrkB) gene-transfected mesenchymal stem cells (TrkB-MSCs) into the ischemic penumbra and investigated whether electroacupuncture (EA) treatment could promote functional recovery from ischemic stroke. For the behavioral test, TrkB-MSCs+EA resulted in significantly improved motor function compared to that obtained with MSCs+EA or TrkB-MSCs alone. At 30 days after middle cerebral artery occlusion (MCAO), the largest number of grafted MSCs was detected in the TrkB-MSC+EA group...
April 22, 2018: Molecular Neurobiology
https://www.readbyqxmd.com/read/29674752/protecting-the-ischaemic-penumbra-as-an-adjunct-to-thrombectomy-for-acute-stroke
#11
REVIEW
Jean-Claude Baron
After ischaemic stroke, brain damage can be curtailed by rescuing the 'ischaemic penumbra' - that is, the severely hypoperfused, at-risk but not yet infarcted tissue. Current evidence-based treatments involve restoration of blood flow so as to salvage the penumbra before it evolves into irreversibly damaged tissue, termed the 'core'. Intravenous thrombolysis (IVT) can salvage the penumbra if given within 4.5 h after stroke onset; however, the early recanalization rate is only ~30%. Direct removal of the occluding clot by mechanical thrombectomy considerably improves outcomes over IVT alone, but despite early recanalization in > 80% of cases, ~50% of patients who receive this treatment do not enjoy functional independence, usually because the core is already too large at the time of recanalization...
April 19, 2018: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/29628940/moderate-to-severe-anemia-is-associated-with-poor-functional-outcome-in-acute-stroke-patients-treated-with-mechanical-thrombectomy
#12
Cetin Kursad Akpinar, Erdem Gurkas, Emrah Aytac
Background: Anemia will negatively affect cerebral collaterals and penumbra. Eventually, it may cause worse clinical outcomes and even increase mortality rates in stroke patients. Anemia has recently been suggested to be an independent risk factor for ischemic stroke. Therefore, we aimed to investigate the effects of the presence of anemia on clinical outcomes in ischemic stroke patients undergoing mechanical thrombectomy. Methods: This was a retrospective study involving the prospectively and consecutively collected data of 90 adult patients between January 2015 and August 2016...
February 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29620280/melatonin-protects-brain-against-ischemia-reperfusion-injury-by-attenuating-endoplasmic-reticulum-stress
#13
Yu Wen Lin, Tsung Ying Chen, Chia Yang Hung, Shih Huang Tai, Sheng Yang Huang, Che Chao Chang, Hsin Yi Hung, E Jian Lee
Endoplasmic reticulum (ER) stress plays a vital role in mediating ischemic reperfusion damage in brain. In this study, we evaluated whether melatonin inhibits ER stress in cultured neurons exposed to oxygen and glucose deprivation (OGD) and in rats subjected to transient focal cerebral ischemia. Sprague-Dawley rats were treated with melatonin (5 mg/kg) or control at reperfusion onset after transient occlusion of the right middle cerebral artery (MCA) for 90 min. Brain infarction and hemorrhage within infarcts were measured...
July 2018: International Journal of Molecular Medicine
https://www.readbyqxmd.com/read/29617449/assessment-of-veins-in-t2-weighted-mr-angiography-predicts-infarct-growth-in-hyperacute-ischemic-stroke
#14
Susumu Yamaguchi, Nobutaka Horie, Minoru Morikawa, Yohei Tateishi, Takeshi Hiu, Yoichi Morofuji, Tsuyoshi Izumo, Kentaro Hayashi, Takayuki Matsuo
BACKGROUND AND PURPOSE: T2*-weighted magnetic resonance angiography (SWAN) detects hemodynamic insufficiency as hypointense areas in medullary or cortical veins. We therefore investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: Magnetic resonance imaging (MRI) records-including SWAN, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA)-of consecutive patients with major vessel occlusion within 6 h from AIS onset were analyzed...
2018: PloS One
https://www.readbyqxmd.com/read/29557515/susceptibility-weighted-imaging-predicts-infarct-size-and-early-stage-clinical-prognosis-in-acute-ischemic-stroke
#15
Song Luo, Lijuan Yang, Yanfei Luo
Susceptibility-weighted imaging (SWI) is a non-invasive technique that can reveal venous structures and iron in the brain. This retrospective study evaluated SWI, relative to other imaging techniques, for determining cerebral infarct size and early-stage clinical prognosis in patients with acute ischemic stroke. Within 3 days after onset, 22 patients with acute ischemic stroke underwent SWI, diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), fluid-attenuated inversion recovery (FLAIR), and magnetic resonance angiography (MRA)...
March 20, 2018: Neurological Sciences
https://www.readbyqxmd.com/read/29556351/perfluorocarbon-enhanced-glasgow-oxygen-level-dependent-gold-magnetic-resonance-metabolic-imaging-identifies-the-penumbra-following-acute-ischemic-stroke
#16
Graeme A Deuchar, David Brennan, William M Holmes, Martin Shaw, I Mhairi Macrae, Celestine Santosh
The ability to identify metabolically active and potentially salvageable ischaemic penumbra is crucial for improving treatment decisions in acute stroke patients. Our solution involves two complementary novel MRI techniques (Glasgow Oxygen Level Dependant (GOLD) Metabolic Imaging), which when combined with a perfluorocarbon (PFC) based oxygen carrier and hyperoxia can identify penumbra due to dynamic changes related to continued metabolism within this tissue compartment. Our aims were (i) to investigate whether PFC offers similar enhancement of the second technique (Lactate Change) as previously demonstrated for the T2 *OC technique (ii) to demonstrate both GOLD metabolic imaging techniques working concurrently to identify penumbra, following administration of Oxycyte® (O-PFC) with hyperoxia...
2018: Theranostics
https://www.readbyqxmd.com/read/29554649/pioglitazone-confers-neuroprotection-against-ischemia-induced-pyroptosis-due-to-its-inhibitory-effects-on-hmgb-1-rage-and-rac1-ros-pathway-by-activating-ppar-%C3%A9
#17
Pingping Xia, Yundan Pan, Fan Zhang, Na Wang, E Wang, Qulian Guo, Zhi Ye
BACKGROUND/AIMS: Recent researches highlighted the protective potential of pioglitazone, a PPAR-γ agonist, in the progression of cerebral ischemia-reperfusion injury. However, there has been no study on the application of pioglitazone in treating ischemic stroke through mechanisms involving pyroptosis. METHODS: The cerebral injury was established by middle cerebral artery occlusion (MCAO). in vitro ischemia in primary cultured astrocytes was induced by the oxygen-glucose deprivation (OGD)...
March 13, 2018: Cellular Physiology and Biochemistry
https://www.readbyqxmd.com/read/29552091/mechanical-thrombectomy-in-a-young-stroke-patient-with-duchenne-muscular-dystrophy
#18
Charlotte Spicher, Ruth Schneider, Peter Mönnings, Christiane Schneider-Gold, Dennis Kallenberg, Bilal Cevik, Carsten Lukas, Ralf Gold, Christos Krogias
Background: Duchenne muscular dystrophy (DMD) is an X-linked recessive skeletal muscle myopathy which is caused by mutations in the dystrophin gene. Lack of dystrophin also results to cardiomyopathy, which raises significantly the stroke risk in DMD-patients. However, data about therapeutic opportunities in the acute setting are scarce in literature. So far, only two cases receiving IV thrombolysis are described, one of them with fatal outcome. Method: Case report of a case of successful mechanical thrombectomy (MTE) in an acute ischemic stroke (AIS) patient with DMD and associated dilatative cardiomyopathy...
2018: Therapeutic Advances in Neurological Disorders
https://www.readbyqxmd.com/read/29543142/use-of-computed-tomography-perfusion-for-acute-stroke-in-routine-clinical-practice-complex-scenarios-mimics-and-artifacts
#19
Carlos Garcia-Esperon, Andrew Bivard, Christopher Levi, Mark Parsons
Background Computed tomography perfusion is becoming widely accepted and used in acute stroke treatment. Computed tomography perfusion provides pathophysiological information needed in the acute decision making. Moreover, computed tomography perfusion shows excellent correlation with diffusion-weighted imaging and perfusion-weighted sequences to evaluate core and penumbra volumes. Multimodal computed tomography perfusion has practical advantages over magnetic resonance imaging, including availability, accessibility, and speed...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29527151/protective-effects-of-l-902-688-a-prostanoid-ep4-receptor-agonist-against-acute-blood-brain-barrier-damage-in-experimental-ischemic-stroke
#20
Kelly M DeMars, Austin O McCrea, David M Siwarski, Brian D Sanz, Changjun Yang, Eduardo Candelario-Jalil
Ischemic stroke occurs when a clot forms in the brain vasculature that starves downstream tissue of oxygen and nutrients resulting in cell death. The tissue immediately downstream of the blockage, the core, dies within minutes, but the surrounding tissue, the penumbra is potentially salvageable. Prostaglandin E2 binds to four different G-protein coupled membrane receptors EP1-EP4 mediating different and sometimes opposing responses. Pharmacological activation of the EP4 receptor has already been established as neuroprotective in stroke, but the mechanism(s) of protection are not well-characterized...
2018: Frontiers in Neuroscience
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