Pathophysiological of stroke

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Stroke is a leading killer worldwide and the third leading cause of death in the United States, behind cardiovascular disease and all cancers. Despite improvements in the stroke mortahty rates in the second half of the twentieth century, stroke occurs in more than 700,000 individuals per year and results in 150,000 deaths. Recent advances in our knowledge of the pathophysiology of stroke have led to evidence-based recommendations on the management of the stroke patient. 

Mergenthaler, P., Dirnagl, Lf., and Meisel, A. (2004) Pathophysiology of stroke Lessons from animal models. Metab. Brain Dis., 19 151-167. 

Since functional outcome and risk of recurrent stroke are, in part, predictable based on the pathophysiologic subtype of stroke, the ability to accurately classify patients based on emergency clinical and imaging data would provide valuable predictive information. Unfortunately, misclassifications of stroke subtypes based on clinical data and a noncontrast CT scan are common. The final subtyping of stroke is made with all available clinical data, but is heavily influenced by neuroimaging studies that identify the location, size, and vascular distribution of the infarct, or that establish that the arteries supplying the region of stroke are stenotic or occluded. 

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... 

Danysz W, Parsons CG, Mobius HJ, et al (2000) Neuroprotective and symptomatological action of memantine relevant for Alzheimer s disease—an unified glutamatergic hypothesis on the mechanism of action. Neurotox Res 2 85-97 Davis SM, Lees KR, Albers GW, et al (2000) Selfotel in acute ischemic stroke possible neurotoxic effects of an NMDA antagonist. Stroke 31 347-354 DeKeyser J (1991) Excitotoxic mechanisms may be involved in the pathophysiology of tardive dyskinesia. Clin Neuropharmacol 14 562-565 Del Dotto P, Pavese N, Gambaccini G, et al (2001) Intravenous amantadine improves levodopa-induced dyskinesias an acute double-blind placebo-controlled study. Mov Disord 16 515-520... 

We gave a short overview of the most important stroke syndromes in the clinical setting. Knowledge of these syndromes helps to understand the complex pathophysiology of cerebral ischemia. Combination of clinical findings with the data from the new and evolving imaging techniques certainly facilitates and improves care for stroke patients. 

Nevertheless, the possibility of combining hypothermia with other types of neuroprotection or thrombolysis is intriguing, and certainly deserves future study. However, if this treatment is ever to impact clinical practice, it is essential that appropriate preclinical studies be conducted. In particular, the rigorous evaluation of these combinations in a variety of ischemic models that most closely simulate the pathophysiology of acute ischemic stroke, is needed. Only after such extensive testing should the possibility of combination therapy be subsequently evaluated in randomized clinical trials. 

Ginsberg M. D. (2003) Adventures in the pathophysiology of brain ischemia penumbra, gene expression, neuroprotection the 2002 Thomas Willis Lecture. Stroke 34, 214-223. 

Knowledge of cerebral blood flow regulation, and the relationship between cerebral blood flow and cerebral metabolism, has had a major influence on the understanding of the pathophysiology of impaired perfusion reserve and acute ischemic stroke (Frackowiak 1986 Marchal et al. 1996 Baron 2001 Rutgers et al. 2004). 

Wise RJ S, Bernardi S, Frackowiak RS J et al. (1983). Serial observations on the pathophysiology of acute stroke. The transition from ischaemia to infarction as reflected in regional oxygen extraction. Brain 106 197-222... 

Subbiah P, Wijdicks E, Muenter M et al (1996). Skin lesion with a fatal neurologic outcome (Degos disease). Neurology 46 636-640 Switzer JA, Hess DG, Nichols FT et al. (2006). Pathophysiology and treatment of stroke in sickle-cell disease present and future. Lancet Neurology 5 501-512... 

Momjian-Mayor I, Baron JC (2005). The pathophysiology of watershed infarction in internal carotid artery disease review of cerebral perfusion studies. Stroke 36 567-577... 

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