What is the Best Treatment for Cerebral Ischemia? - Oren Zarif - Cerebral Ischemia
Cerebral ischemia, also known as brain ischemia, is a common cause of acute brain injury. Inadequate blood flow to the brain can result in multiple consequences, including cerebral infarction and global hypoxic ischemic encephalopathy, both of which can be life-threatening and may cause permanent disability. This activity reviews the etiology of cerebral ischemia, discusses the role of the interprofessional team in evaluation, and summarizes management options.
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The symptoms of brain ischemia vary among individuals, but the most common are weakness and decreased sensation, headache, difficulty speaking, or swallowing. Patients can also experience altered or deteriorated consciousness. Other potential symptoms include urinary incontinence, vertigo, and loss of consciousness. However, these symptoms should not be ignored unless you are a medical emergency. There is no cure for cerebral ischemia, but it can be treated.
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Once ischemic brain tissue is damaged, it stops working and begins dying. This process takes anywhere from two to five minutes, depending on the severity of the ischemia. If left untreated, the brain's tissue may deteriorate to the point of necrosis. The brain is particularly vulnerable to this condition due to selective vulnerability, which affects brain tissue in specific areas. For example, pyramidal cells in the CA1 region of the hippocampal area are highly susceptible to ischemia.
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Treatment for acute ischemic stroke usually involves anticoagulants and the use of medications. Alteplase is one medication approved for the treatment of acute ischemic stroke. It has shown promising results in patients when compared to placebo treatments. Anticonvulsants are also often prescribed. The outcome of the treatment depends on the severity of the stroke, the patient's overall condition, and the presence of clots. So, what is the best treatment for cerebral ischemia?
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The most common causes of cerebral ischemia are heart attacks and stroke. These conditions are characterized by extremely low blood pressure, which results in inadequate oxygenation of tissue. When heart attacks do not end in immediate treatment, the brain begins to swell and blood clots form. Ultimately, brain tissues are completely deprived of oxygen and will die. In addition to heart attacks, cerebral ischemia can result from events involving other body parts. Some people have inherited a heart defect that increases their risk of developing blood clots.
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Other causes of cerebral ischemia are vascular inflammation and tumors. Tissue plasminogen activator is a medication approved by the FDA for acute ischemic stroke. TPA can lyse arterial thrombus, reduce the severity of ischemic brain injury, and reduce the risk of distant bleeding complications. Someday, TPA could be used by paramedics to treat ischemic stroke in the field.
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A study published recently found that excessive activation of Ca2+-dependent catabolic enzymes contributes to increased free radical production and inflammation after cerebral ischemia. In addition, the activation of phospholipases (PLA2) by the NMDA receptor is an important contributor to the destruction of regulatory and structural proteins in the brain. Genetic ablation of PLA2 reduces brain injury in animal models of cerebral ischemia.
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The study also identified different types of global ischemia. In the latter, the brain is deprived of oxygen for prolonged periods of time, resulting in severe damage. As with ischemic stroke, the symptoms of cerebral ischemia range from mild to severe, and lasts from a few seconds to several minutes. The condition is sometimes referred to as transient ischemic attack or TISA. Although the cause of cerebral ischemia is not known, it is still important to identify it and seek treatment.
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The initial workup for suspected cases of cerebral ischemia should include basic laboratory tests such as a complete blood count, coagulation factors, EKG, and cardiac enzymes. A stat non-contrast head CT should rule out other possible causes of cerebral ischemia, including hemorrhage or mass lesions. Vascular imaging is also helpful for acute stroke etiology. If the stroke is acute, a large vessel occlusion may be obvious.
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Treatment options for ischemic stroke depend on the severity of the condition. Acute cerebral ischemia may be fatal, but if treated early, most people can recover basic function. However, the therapeutic window of antiapoptotic therapies may be prolonged. A delay of more than one day can result in the risk of rescuing too-damaged cells. In addition, the therapeutic window of antiapoptotic agents is long, and the potential for apoptosis is high.
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A model of global incomplete brain ischemia in a dog is a useful tool for research on ischemic injury. Because it does not produce a frank infarct and causes regional neuronal damage, it allows long-term survival experiments. These experiments can identify the early mechanisms of ischemic neuronal death, as well as investigate the post-ischemic effects of brain ischemia. There are several other models for studying the effects of cerebral ischemia.