Causes and Management of Cerebral Ischemia - Oren Zarif - Cerebral Ischemia
Cerebral ischemia is a common mechanism of acute brain injury. It is a medical emergency that can cause serious complications such as cerebral infarction or global hypoxic ischemic encephalopathy. This activity reviews the causes of cerebral ischemia and the role of the interprofessional team in the evaluation and management of the condition. The goal of this activity is to help clinicians better understand this complication.
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The symptoms of cerebral ischemia can be categorized into two types: focal and global. Focal ischemia affects a specific area of the brain, and global ischemia occurs when blood flow to the entire brain is reduced or completely cut off. Treatments for both types depend on the extent of the cerebral ischemia, the cause of the symptoms, and the region of the brain affected. Surgery is generally only considered an option for severe cases.
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Global cerebral ischemia results from complete cessation of CBF, and cytotoxic edema and vasogenic edema result early in the disease. The breakdown of the blood-brain barrier results in glutamate release, which leads to massive intracellular calcium concentration and neuronal death. Furthermore, brain injury is exacerbated by tissue acidosis, especially in hyperglycemic states.
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Cerebral ischemia is often reversible, although in severe cases, cerebral infarction may occur, resulting in significant disability or death. Angiographic findings of narrowed vessels are useful in determining the severity of the condition. Clinical deficits often accompany angiographic evidence of cerebral ischemia. Sometimes they occur independently of each other. If you suspect cerebral ischemia, consult a neurological specialist.
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Imaging techniques for the diagnosis of cerebral ischemia include computed tomography and ultrasonography. However, these methods are limited in detecting ischemia at an early stage. In addition, some studies have shown that 18F-based positron emission tomography probes can help identify neuronal death. Additionally, a marker of neuronal death is mitochondrial complex I activity. In addition to ultrasonography, magnetic resonance imaging has improved accuracy. It can differentiate damaged regions earlier than other neuroimaging techniques, and it does not use radioactive tracers.
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The results of this study suggest that cerebral ischemia is most often caused by a blockage of an artery. The resulting lack of blood flow and oxygen to the brain is known as an ischemic stroke. Cerebral ischemia may result in a transient ischemic attack, also known as a mini-stroke. Once brain tissue dies, the loss of function is permanent. This is the most common cause of a stroke.
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Although the symptoms of cerebral ischemia may range from mild to severe, a short-term lack of oxygen in the brain can result in irreversible damage. This type of ischemia is also known as an ischemic stroke, and the symptoms of cerebral ischemia may last for just a few seconds or up to several minutes. It is also called a transient ischemic attack. However, the effects of cerebral ischemia are typically temporary.
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Despite the widespread concern about the risks associated with ischemic stroke, there are ways to prevent it. The most common type is called ischemic stroke, which is characterized by acute ischemia in one brain artery. This type of ischemic stroke is responsible for more than half of all strokes worldwide and is one of the leading causes of death and disability in the US and throughout the world. The most common symptom is syncope, which is a temporary ischemia of the entire brain.
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The initial workup for cerebral ischemia will typically include basic laboratory tests including a complete blood count, coagulation factors, EKG, and cardiac enzymes. Additionally, stat non-contrast head CT is recommended to rule out hemorrhage or a mass lesion. Vascular imaging is especially helpful for the etiology of an acute stroke. The presence of a large vessel occlusion may be evident on the CT.
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Another method, called molecular fMRI, is used to monitor critical pathophysiological processes in the brain during cerebral ischemia. The MRI probes are charged in Ca-free and Ca-bound form and are administered intracranially. This allows for the detection and monitoring of cerebral ischemia before it leads to irreversible damage to the brain. This method provides a comprehensive picture of the anatomy of the brain during an ischemic stroke.
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A focussed medical history should be obtained from patients who have experienced a stroke. The patient's current medication list is essential. If the patient is taking any anticoagulants, thrombolytics are contraindicated. A careful examination of the patient's vascular risk factors is critical. Patients must also be evaluated for any other conditions that may have contributed to the onset of the stroke. This will help determine the best treatment for the patient.