Cerebral Ischemia - Oren Zarif - Cerebral Ischemia
Cerebral ischemia is a disorder of brain blood flow that can cause severe neurological problems and death. Its symptoms can include irregular discoloration of the brain, blurring of gray-white matter zones, and loss of neurons. It can also lead to gliosis, or death of brain cells. While most parts of the body undergo coagulative necrosis, the brain suffers from a process known as liquefactive necrosis, which appears as a viscous material containing neutrophils and cell debris.
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The diagnosis of cerebral ischemia depends on the underlying cause and the patient's symptoms. In some cases, severe infections or a ruptured blood vessel can lead to low blood pressure. Trauma can also cause large blood loss. All of these causes can reduce blood flow to the brain. Cerebral ischemia may affect the entire brain or just a specific part of the brain. Another type of ischemic stroke is focal ischemia, which can occur in one area of the brain. Another possible cause of cerebral ischemia is a blood clot or a small clot called an embolism.
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When the brain is ischemic, the blood supply is interrupted to the core of the brain tissue. Necrosis, which causes brain tissue to die, can occur in less than five minutes. Cerebral ischemia is a serious condition and needs immediate medical attention. There is no single cause of cerebral ischemia, and it can affect anyone, from young children to the elderly. With proper diagnosis and treatment, you can make an informed decision about your health.
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During the initial workup of a patient with suspected cerebral ischemia, basic laboratory tests such as a complete blood count and coagulation factors are necessary to rule out other causes. Cardiovascular enzymes and an EKG are also important to identify a rapidly growing tumor. In cases of suspected large artery occlusion, a CT may be subtle during the first few hours. Other signs include a dense middle cerebral artery sign and effacement of the insular cortical ribbon. Small infarcts may only be visible on diffusion-weighted MRI.
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Cerebral ischemia can be categorized as either focal or global. The first occurs when blood clots form in a particular artery in the brain. The latter occurs when the blood supply to the brain has been drastically reduced or stopped. The severity of symptoms and region affected will determine the best treatment. There is no known cure for cerebral ischemia, but if you live with the symptoms, the right treatment can help.
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ASIC1a and ASIC2a are key components in Ca2+ permeability. Inhibitors of these proteins can block the function of aSIC1a in the brain. These drugs are administered intracerebroventricularly and have a protective effect on stroke. ASIC1a knockout mice are protective. The exact mechanism of ASIC1a inhibition is not yet known, but it is thought that TRP proteins play a role in Ca2+-mediated neuron death and ischemic stroke.
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Delayed cerebral ischemia is a major cause of death in patients with subarachnoid hemorrhage. Up to 30% of these patients will develop delayed cerebral ischemia, leaving them with limited life quality. The severity of the initial hemorrhage determines the risk of delayed cerebral ischemia. Therefore, it is important to be aware of the risk factors that affect a patient's chances of developing the condition.
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In one study, researchers identified a correlation between SCA infusion and the presence of coexisting intracranial aneurysms in patients with ischemic brain. While neither agent affected the other's MRI signal, they found that both agents responded to intracranial hypertension. They also noted a decrease in the T1-weighted MRI signal during cerebral ischemia, but this signal recovered when brain tissue was reperfused.
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The pathophysiology of ischemic stroke includes the death of neurons that are located in the penumbra of the lesion. The periinfarct zone is a zone of less severely affected tissue, rendered metabolically active but functionally silent by reduced blood flow. This boundary region is called the ischemic penumbra and may represent half of the lesion volume during the early stages of ischemia. As a result, the periinfarct zone represents a promising poststroke therapy target. Furthermore, recent studies have suggested that many neurons in this periinfarct zone undergo apoptosis after several hours.
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In recent publications and guidelines, a reserve term has been added to the definition of DCI: DCI is any infarction of the brain that is demonstrated on CT or MRI within six weeks of the aneurysm rupture. This is now considered the primary determinant of long-term cognitive outcomes in patients with SAH. Acute DCI requires prompt intervention for optimal outcomes. It is important to identify symptoms early and seek a reversal of the ischemia.