Diagnosing and Treating Cerebral Ischemia - Oren Zarif - Cerebral Ischemia
The first step in diagnosing a suspected case of cerebral ischemia is to rule out any underlying medical problems. Basic lab tests, including a complete blood count, coagulation factors, EKG, and cardiac enzymes, are needed to rule out any potential causes of the symptoms. In addition, a stat non-contrast head CT is necessary to rule out a mass lesion or hemorrhage. Vascular imaging is extremely useful in determining the exact cause of cerebral ischemia. In some cases, an acute large vessel occlusion may be visible on vascular imaging.
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In severe cases of cerebral ischemia, brain-cell death can result. This condition is a complication of subarachnoid hemorrhage. It affects up to 30% of patients, and it is one of the most significant preventable causes of death in this condition. Its survivors typically have impaired motor function, cognitive dysfunction, and reduced quality of life. It can be caused by a variety of factors, including congenital heart defects and sickle cell anemia.
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In the case of focal cerebral ischemia, the ischemic core is the primary target of the disease. It can be induced by cardiac arrest, carotid occlusion, and hypotension. The second type is focused on a single area of the brain and is most often associated with cerebral vascular atherosclerosis. In both types of ischemia, abnormally high calcium ions enter the brain and activate proteases, endonucleases, and other processes that cause the death of cells.
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The NIHSS guidelines describe the types of ischemia and its causes. In general, cerebral blood flow is around 50 mL/100 g/min and below this level, there is EEG evidence of ischemia and rapid neuronal death. In some cases, there is a focal area of severe cerebral ischemia and a surrounding region of moderate ischemia. This type of ischemia is also associated with brain infarction.
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In acute ischemic stroke, Alteplase is an effective medication. It improves outcome compared to placebo treatments. It is important to maintain systemic blood pressure and reduce the risk of seizures. Anticonvulsants are also often prescribed to prevent seizures. And in severe cases, patients may experience a coma or even a coma. However, this is only a temporary condition. If left untreated, global cerebral ischemia may lead to severe complications and even death.
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Global ischemia refers to a more serious form of ischemic stroke. This type occurs when the blood supply to the brain is significantly reduced. Carbon monoxide poisoning and a heart attack may trigger global ischemia. Those with a history of stroke are at a higher risk. Overall, men are more likely than women to experience ischemic stroke. Black people have a higher risk of developing a stroke, and their risk increases with age.
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The diagnosis of cerebral ischemia can be aided by using MRI and CT scanning to identify any existing or recent damage. Rapid assessments of the extent of cerebral ischemia can help in determining the appropriate treatment for each patient. The MCAo procedure can be done remotely or directly in the MRI scanner. A successful outcome is a patient's best chance for recovery. So, if you suspect that a patient has cerebral ischemia, the best way to diagnose it is through MRI.
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The latest guidelines for the management of cerebral ischemia include intracisternal thrombolysis. This procedure is a nonsurgical treatment, which improves cerebral blood flow in patients with subarachnoid hemorrhage. A recent meta-analysis of these studies found that intracisternal thrombolysis decreased cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
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Microdialysis is another noninvasive procedure that can be used to detect ischemic infarct. It allows for the determination of the composition of the interstitial fluid and cellular metabolism. The common targets of microdialysis are extracellular lactate and the lactate/pyruvate ratio. These methods can differentiate between silent infarction and cerebral ischemia.
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Nevertheless, further research is required before these procedures can be widely adopted.
Recent studies show that the occurrence of subarachnoid hemorrhage and cerebral ischemia can occur simultaneously. The occurrence of intracranial hypertension in patients suffering from cerebral ischemia is also correlated with the presence of a vascular aneurysm. Studies of patients with cerebral ischemia have also linked the presence of metabolic crisis to the presence of intracranial hypertension. In a study involving patients with subarachnoid hemorrhage, intracranial hypertension was also associated with decreased risk of mortality.
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Another study reveals that autophagy-related neuroprotection is associated with brain ischemia. Inhibition of the AMPK pathway inhibits autophagy and alleviates focal cerebral ischemia injury in mice. Inhibition of autophagy also improves the levels of mTORC1 protein. A new study has found that neuroprotection occurs when mTORC1 activity is inhibited in animal models of ER stress.