Cerebrovascular Diseases
Amy J. Litterini, Christopher M. Wilson in Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Signs and symptoms of stroke include: a sudden onset of numbness in the face or extremities, particularly on one side of the body; sudden confusion; difficulty in speaking and/or understanding speech; altered gait pattern; reduced vision in one or both eyes; and/or sudden onset of severe headache with no known origin. The formal diagnosis of stroke is made through a medical examination including: neurologic testing and blood pressure assessment; laboratory assessments to analyze the clotting cascade; a CT of the head and/or MRI of the brain; and in some cases, a cerebral angiogram to assess the blood flow of the brain and neck. Differential diagnosis of stroke includes seizures, hypoglycemia, migraine headaches, systemic infection, encephalitis, toxic metabolic syndromes, dementia, and other neurological disorders.4 Carotid ultrasound and echocardiogram are confirmatory tests also used to reveal underlying causes for stroke, such as blockages elsewhere, causing blood clots to travel into the bloodstream.
Advances in Portable Neuroimaging and Their Effect on Novel Therapies
Yu Chen, Babak Kateb in Neurophotonics and Brain Mapping, 2017
Stroke, despite being ranked as the top neurological disorder, has only one acute therapy. That therapy is for the majority of patients that have acute ischemic stroke as opposed to hemorrhagic stroke. Acute cerebral ischemia can benefit from the only approved therapy being thrombolysis with tissue plasminogen activation (tPA). But tPA must be administered within the first few hours after symptoms, and must not be given to patients with any evidence of acute intracranial hemorrhage, otherwise the therapy could cause further brain damage or kill the patient. The quickest and easiest way to diagnose acute ischemic stroke is with a CT scan. However, it takes a long time for a patient to be transported to an ER, undergo neurological workup, and go to a CT scan, to interpret the scan, and then to administer therapy. As a result, many patients who arrive in the emergency department for work-up of stroke are often outside the window for treatment and therefore never receive tPA. Much time can be saved by bringing the necessary items to a patient’s point of origin and perform the workup in situ. Hitherto, the limiting factor was the availability of an ambulance-sized CT machine. But now, portable CT can be installed in ambulances turning them into stroke mobiles for mobile diagnosis and treatment. Bringing the team and ability to diagnose acute stroke with portable CT to the patient enables a much larger percentage of acute stroke patients to receive tPA and therefore have their stroke treated limiting the extent of brain infarction.
Etienne
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
The acute occlusion of his right internal carotid artery by fresh thrombus provided the opportunity for his health care team to give thrombolytic therapy to re-establish blood flow and to prevent and even reverse neurological damage. In this case, he had complete large proximal vessel occlusion, which is more amenable to intra-arterial (IA) therapy than to IV therapy. The common practice, as in this case, is to use an initial dose of IV tPA and, if there is no immediate clinical improvement, to then use clot extraction methods coupled with IA tPA. tPA catalyzes the conversion of plasminogen to plasmin, resulting in the lysis of newly formed clots. If given within 4.5 hours of the onset of symptoms, this treatment is now considered the standard of care for acute ischemic stroke.
Making a case for the right ‘-ase’ in acute ischemic stroke: alteplase, tenecteplase, and reteplase
Published in Expert Opinion on Drug Safety, 2019
Katleen Wyatt Chester, Megan Corrigan, J. Megan Schoeffler, Michelle Shah, Florence Toy, Barbara Purdon, George M. Dillon
The most common type of stroke is an acute ischemic stroke (AIS), which accounts for 87% of all strokes [1]. Ischemic stroke is caused by a blood clot or blockage in a cerebral artery that interrupts blood flow to the brain, resulting in neurological dysfunction [4]. The American Heart Association (AHA)/American Stroke Association (ASA) guidelines for the early management of patients with AIS recommend administration of intravenous (IV) alteplase in eligible patients within 4.5 h of symptom onset [5]. Alteplase is a recombinant human tissue plasminogen activator approved by the US Food and Drug Administration (FDA) for the management of AIS [6]. Alteplase binds to fibrin in a thrombus and activates fibrin-bound plasminogen to active plasmin, thereby inducing fibrin degradation and thrombolysis [6]. In clinical trials, patients who received alteplase within 4.5 h after onset of AIS symptoms were more likely to have minimal or no disability as well as improved Barthel Index, modified Rankin Scale, and National Institutes of Health Stroke Scale scores at 3 months compared with those who received placebo [7–9]. Widespread use of alteplase for the treatment of AIS has been limited by concerns of hemorrhagic complications, specifically symptomatic intracerebral hemorrhage [10]. However, the significantly improved outcomes at 3 months in patients with AIS treated with alteplase generally outweigh the risk for hemorrhagic events in these patients [7–9].
The role of high high-sensitivity C-reactive protein levels at admission on poor prognosis after acute ischemic stroke
Published in International Journal of Neuroscience, 2019
Zhiyou Cai, Wenbo He, Feng-Juan Zhuang, Yan Chen
Stroke, also known as cerebrovascular accidents or brain attack, occurs if the flow of oxygen-rich blood to a portion of the brain is blocked, resulting in brain cell death and loss of neural function. Stroke is one of the most frequent causes of death and disability worldwide, such as the first leading cause of death in China and the fourth leading cause of death in the United States [1,2]. There are two main types of stroke: ischemic stroke (due to lack of blood flow, thrombosis or embolism) and hemorrhagic stroke (due to bleeding). An ischemic stroke is at the onset of an emergency when a clot or a mass clogs a blood vessel, cutting off the blood flow to brain cells. Ischemic stroke is the most common type of stroke while about 85% of cerebrovascular accidents are ischemic stroke. An acute cerebral infarction (ACI), the most common ischemic stroke, typically results from brain arterial thrombosis or embolism. A focal brain necrosis due to cerebral infarction affects the corresponding neurons, glia, vessels and all matched brain tissue elements.
Thrombus heterogeneity in ischemic stroke
Published in Platelets, 2021
Senna Staessens, Simon F. De Meyer
The main cause of ischemic stroke is a thrombus in the blood that prevents sufficient blood supply to the brain. The mainstay of primary care is aimed at restoring the blood flow to the brain as fast as possible by recanalizing the occluded blood vessel. Recanalization can be achieved via pharmacological lysis of the occluding thrombus using recombinant tissue plasminogen activator (rt-PA) or via an endovascular thrombectomy intervention that physically removes the thrombus from the circulation. As central target, the thrombus itself is most likely a key factor dictating recanalization success rates in stroke patients. The composition and architecture of ischemic stroke thrombi has become a hot topic in stroke research, mainly instigated by the emergence of thrombectomy procedures that started to provide patient thrombus material for research [1]. Better understanding of thrombus organization and structure is not only necessary to increase our understanding of the pathophysiology that underlies the initial event of thrombus formation, but is also important to further improve thrombus-targeting therapies in ischemic stroke. Accumulating evidence points toward a complex and variable structure of ischemic stroke thrombi, with involvement of thrombotic factors such as platelets and fibrin, as well as inflammatory components such as leukocytes and neutrophil extracellular traps. In this review, we discuss the main thrombus components that have been recently characterized in ischemic stroke thrombi. We also consider how thrombus heterogeneity can impact stroke treatment.
Related Knowledge Centers
- Bleeding
- Brain Ischemia
- Cell Death
- Cerebral Circulation
- Dizziness
- Expressive Aphasia
- Receptive Aphasia
- Hemiparesis
- Brain
- Intracranial Hemorrhage