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What Are the Different Types of Cerebral Ischemia? - Oren Zarif - Cerebral Ischemia

Cerebral ischemia is a serious medical condition in which there is a reduction in blood flow to an area of the brain. This decrease in blood flow is usually limited to a specific area of the brain. Focal ischemia is a form of cerebral ischemia and may be caused by a blood clot or an embolism. This condition is characterized by a drop in cerebral blood flow of ten to thirty percent.

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Global ischemic injury causes changes in neuronal histology within 12 to 24 hours. In addition, there may be swelling or shrinkage of neurons. In addition, "red neurons" may form due to cytoplasmic eosinophilia, nuclear pyknosis, or necrotic changes. Additionally, edema can cause empty spaces within the parenchyma and widened pericellular spaces.

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Animal models of cerebral ischemia are often used to study the effects of neuroprotective drugs or other therapeutic strategies. The underlying mechanisms of injury are well studied using various animal models, which allow researchers to predict how a given drug will work in humans. Moreover, animal models of ischemia provide a valuable means of identifying targets for neuroprotection. The key to preventing the onset of this condition is to understand the mechanism of injury.

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There are two main types of models of acute ischemic stroke. One of these is the two-vessel (2-VO) model. The two-vessel model is an alternative to the 4-VO model. In this model, cerebral blood flow decreases to less than five percent of the control level in the cortex, thalamus, and midbrain. The two-vessel model has also shown that pharmacological agents such as trimethaphan and endovascular therapy with mechanical thrombectomy can reduce the ischemia-induced blood flow to these areas.

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Another type of ischemic stroke is global ischemia, which occurs when the amount of oxygen reaching the brain is reduced significantly. It may also be caused by a heart attack or carbon monoxide poisoning. People with a history of stroke are at a higher risk of developing global ischemia. Age and race play a major role in the development of cerebral ischemia. The risk increases with age, with men being more at risk than women.

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Two common causes of cerebral ischemia are a heart attack and congenital heart disease. These events cause extremely low blood pressure and a clot to form in the blood. This prevents oxygen-carrying blood flow to the brain. People with congenital heart defects are more susceptible to blood clots, but other events can also lead to cerebral ischemia. Those with sickle-cell anemia are predisposed to blood clots.

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The initial workup of cerebral ischemia involves basic lab tests, such as a complete blood count, coagulation factors, and cardiac enzymes. In cases where a patient's symptoms are due to a large vessel occlusion, a stat non-contrast head CT is indicated to rule out a mass lesion or hemorrhage. Vascular imaging may be helpful for the etiology of acute stroke. Acute large vessel occlusion may be obvious.

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The periinfarct area is surrounded by a border region of less severely affected tissue. Reduced blood flow and metabolic activity in the border region renders this zone functionally silent. This border area, referred to as the ischemic penumbra, represents the opportunity for post-stroke therapy and neuroprotection. However, recent research indicates that neurons in this region undergo apoptosis even after several hours or days.

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Recent research on acute stroke has provided insights into the physiologic mechanisms of cerebral ischemia and the role of neuroprotective drugs. Despite the many challenges that arise in the management of ischemic brain damage, animal models have proven to be a useful tool for learning about the brain and how to prevent or treat it. For example, in rats, reversible middle cerebral artery occlusion can be performed without craniectomy, and ischemia caused by a single stroke can be reversed in a monkey brain after one hour of complete ischemia.

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In humans, ischemia can occur in two types: focal ischemia and global ischemia. Focal ischemia occurs when a blood clot blocks an artery in a specific area of the brain while global ischemia occurs when little blood is delivered to the brain during a cardiac arrest. Treatment for both types of cerebral ischemia depends on the severity of the symptoms and the region affected. Surgical interventions are recommended only in the most severe cases.

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Researchers have used gerbils as models for global ischemia. The gerbil has unique vascular anatomy that allows researchers to study this condition. The gerbil lacks the posterior communicating artery, which connects the vertebrobasilar arterial system with the carotid artery. In gerbils, a bilateral common carotid artery occlusion causes global ischemia, reducing CBF to zero in most animals.

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