Hemorrhagic stroke pathophysiology

The pathophysiology of hemorrhagic stroke is not as well studied as that of ischemic stroke however, it is a more complex process than previously thought. Much of the process is related to the presence of blood in the brain tissue and/or surrounding... 

Many individuals with LA also harbor lacunar and/or cortical infarcts. Presence of LA serves as an intermediate surrogate both for ischemic stroke and intracerebral hemorrhage as they all share similar risk factors and similar pathophysiological mechanisms (Inzitari 2003). LA is widely found in dementing illnesses, such as Alzheimer s disease, vascular dementia, and cerebral autosomal dominant arteri-opathy with subcortical infarcts and leukoencepha-lopathy (CADASIL). Failure of blood supply in the... 

There are limitations to the information on cerebrovascular pathophysiology in vivo that can be provided by CT and conventional MRI. Specifically, these include lack of sensitivity for acute ischemic stroke, difficulty in determining infarct age, lack of demonstration of the ischemic penumbra and low sensitivity and specificity for primary intracerebral hemorrhage in the case of MRI. New imaging techniques address some of these deficiencies and thereby impact on the management of patients with acute stroke. 

Recent advances in new MRI sequences that allow further characterization of ischemia have led to increased interest in using gradient-echo (GRE) MRI to detect hemorrhage (Ch. 10). This would avoid having to perform two imaging modalities in acute stroke, CT followed by MRI, in patients in whom further characterization of pathophysiology is necessary, for instance to determine selection for thrombolysis. 

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