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Neuronal injuries in cerebral infarction and ischemic stroke: From mechanisms to treatment (Review).International Journal of Molecular... Feb 2022Stroke is the leading cause of disabilities and cognitive deficits, accounting for 5.2% of all mortalities worldwide. Transient or permanent occlusion of cerebral... (Review)
Review
Stroke is the leading cause of disabilities and cognitive deficits, accounting for 5.2% of all mortalities worldwide. Transient or permanent occlusion of cerebral vessels leads to ischemic strokes, which constitutes the majority of strokes. Ischemic strokes induce brain infarcts, along with cerebral tissue death and focal neuronal damage. The infarct size and neurological severity after ischemic stroke episodes depends on the time period since occurrence, the severity of ischemia, systemic blood pressure, vein systems and location of infarcts, amongst others. Ischemic stroke is a complex disease, and neuronal injuries after ischemic strokes have been the focus of current studies. The present review will provide a basic pathological background of ischemic stroke and cerebral infarcts. Moreover, the major mechanisms underlying ischemic stroke and neuronal injuries are summarized. This review will also briefly summarize some representative clinical trials and up‑to‑date treatments that have been applied to stroke and brain infarcts.
Topics: Animals; Brain Ischemia; Cerebral Infarction; Humans; Ischemic Stroke; Neurons; Neuroprotection; Oxidative Stress
PubMed: 34878154
DOI: 10.3892/ijmm.2021.5070 -
Laeknabladid May 2014Eight of ten strokes are due to cerebral ischemia, two from cerebal hemorrhage. Stroke is the most common cause of disability, the second commonest cause of dementia and... (Review)
Review
Eight of ten strokes are due to cerebral ischemia, two from cerebal hemorrhage. Stroke is the most common cause of disability, the second commonest cause of dementia and the fourth commonest cause of death in the developed world. The incidence of stroke is 150-200/100.000 individuals/ year. One of every seven individuals suffers from stroke in their lifetime. In this article the epidemiology, risk factors, pathophysiology and symptoms of cerebral ischemia will be reviewed.
Topics: Brain Ischemia; Cerebral Angiography; Cerebral Infarction; Diffusion Magnetic Resonance Imaging; Humans; Incidence; Predictive Value of Tests; Prognosis; Risk Factors; Stroke
PubMed: 24846950
DOI: 10.17992/lbl.2014.05.543 -
European Journal of Physical and... Jun 2017The incidence of stroke is high in China. The dysphagia caused by cerebral infarction (CI), seriously affects patients' life quality, and even endangers patients' lives.... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
The incidence of stroke is high in China. The dysphagia caused by cerebral infarction (CI), seriously affects patients' life quality, and even endangers patients' lives. It is necessary to explore how to improve dysphagia caused by CI.
AIM
To compare the effects of rehabilitation training on dysphagia and psychological state after CI between Shaker exercise and chin tuck against resistance (CTAR) exercise.
DESIGN
Control study. Blind.
SETTING
Inpatients.
POPULATION
A total of 90 patients with dysphagia after CI were divided into CTAR group, Shaker group and control group by random digit table (each group with 30 patients).
METHODS
Video fluoroscopic swallowing study (VFSS) and Self-Rating Depression Scale (SDS) were performed on all patients before intervention. VFSS was evaluated based on Penetration-Aspiration Scale. All patients received routine treatments including internal medicine, traditional rehabilitation training and routine nursing. The patients in control group only receive the routine treatments. Besides the routine treatments, the patients in CTAR group also received CTAR exercise, and the patients in Shaker group also received Shaker exercise. VFSS was performed again on all patients, respectively, 2, 4, and 6 weeks after exercise. SDS was performed again on all patients 6 weeks after exercise.
RESULTS
There were no statistical differences amongst the three groups in VFSS and SDS before intervention (P>0.05). After intervention, all patients had various degrees of improvement for dysphagia in the three groups, especially between 2 and 4 weeks in CTAR and Shaker groups. The total effective rate was significantly higher in CTAR group (86.67%) and Shaker group (76.67%) than in control group (43.33%) (all P<0.05). The scores of SDS was significantly lower in CTAR group than in Shaker group and control group 6 weeks after intervention (all P<0.05).
CONCLUSIONS
For the patients with dysphagia after CI, CTAR exercise can significantly relieve depression and has the similar effect on improving swallowing function as compared with Shaker group.
CLINICAL REHABILITATION IMPACT
This study suggests that in conscious patients CTAR exercises have greater impact on CI-related depression than Shaker exercises.
Topics: Aged; Aged, 80 and over; Cerebral Infarction; Chin; Deglutition Disorders; Depressive Disorder; Exercise Therapy; Female; Humans; Male; Middle Aged; Treatment Outcome
PubMed: 27830923
DOI: 10.23736/S1973-9087.16.04346-X -
European Neurology 2019We offer here an observation written in 1866 by Jean-Martin Charcot, accompanied by drawings made during the autopsy of a patient who died of "cerebral softening."...
We offer here an observation written in 1866 by Jean-Martin Charcot, accompanied by drawings made during the autopsy of a patient who died of "cerebral softening." Focusing mainly on French medical progress at the time, our survey of the state of knowledge of cerebrovascular pathology indicates that Charcot completely explained the pathophysiology of cerebral infarction, describing the ulceration of an atheromatous plaque at the intima of an artery, on which a clot aggregates, blocks the vessel, or releases embolus downstream, causing cerebral ischemia and parenchymal lesions. Using the term "cholestérine" (cholesterin), the name of cholesterol at the time, he identified the biological nature of atheromatous plaques, and made detailed drawings. This observation, included in the famous thesis of Ivan Poumeau, indicates that Charcot did not neglect cerebrovascular pathology, ischemic in this case, but also pathology caused by hemorrhaging, as in the thesis of Charles Bouchard. This interest, which we see clearly during his first decade at Hôpital de la Salpêtrière, gradually turned toward other neurological pathologies that ensured his fame as a founder of neurology more enduringly and overshadowed the conceptual advances he made in the vascular domain.
Topics: Humans; Anatomy, Artistic; Autopsy; Cerebral Infarction; Cholesterol; France; History, 19th Century; Neurology; Plaque, Atherosclerotic
PubMed: 31487724
DOI: 10.1159/000502576 -
Journal of Pharmacological Sciences Jan 2021Cerebral ischemia/reperfusion injury activates microglia, resident immune cells in the brain, and allows the infiltration of circulating immune cells into the ischemic... (Review)
Review
Cerebral ischemia/reperfusion injury activates microglia, resident immune cells in the brain, and allows the infiltration of circulating immune cells into the ischemic lesions. Microglia play both exacerbating and protective roles in pathological processes and are thus often referred to as "double-edged swords." In ischemic brains, blood-borne macrophages play a role that is distinct from that of resident activated microglia. Recently, the metabolic alteration of immune cells in the pathogenesis of inflammatory disorders including cerebral infarction has become a critical target for investigation. We begin this review by describing the multifaceted functions of microglia in cerebral infarction. Next, we focus on the metabolic alterations that occur in microglia during pathological processes. We also discuss morphological changes that take place in the mitochondria, leading to functional disturbances, accompanied by alterations in microglial function. Moreover, we describe the involvement of the reactive oxygen species that are produced during aberrant metabolic activity. Finally, we discuss therapeutic strategies to ameliorate aggravative changes in metabolism.
Topics: Cerebral Infarction; Glycolysis; Humans; Inflammation; Macrophages; Microglia; Mitochondria; NF-E2-Related Factor 2; Reactive Oxygen Species
PubMed: 33357771
DOI: 10.1016/j.jphs.2020.11.007 -
BMC Neurology Jun 2022So far, the diagnosis of acute artery of percheron (AOP) infarction is uncommon. In this study, patients with acute AOP infarction were studied to explore the...
BACKGROUND
So far, the diagnosis of acute artery of percheron (AOP) infarction is uncommon. In this study, patients with acute AOP infarction were studied to explore the relationship of imaging findings, clinical manifestations and prognosis of acute AOP infarction.
MATERIALS
A total of 23 patients with acute AOP infarction in our institution from 2014 to 2019 were reviewed retrospectively. All cases were evaluated by computed tomography (CT) and magnetic resonance imaging (MRI). The modified Rankin scale (MRS), blood examination, electrocardiogram and transthoracic echocardiography were used for detailed clinical and prognostic evaluation. All standard risk factors for these patients were recorded. The MRS scores were performed 90 days after discharge.
RESULTS
Four different types of acute AOP infarction were identified: (a) bilateral paramedian thalamic infarction (BPTI, 52%); (b) bilateral paramedian thalamic with rostral midbrain infarction (BPTRMI, 30%), (c) bilateral paramedian and anterior thalamic infarction (BPATI, 13%), and (d) bilateral paramedian thalamic with red nuclei infarction (BPTRNI, 4%). These patients had consciousness disorder, memory dysfunctions, vertical gaze paresis and mesencephalothalamic syndrome. The 65% of patients with BPTI and BPATI experienced relatively good functional recovery and could carry out daily life activities (MRS score ≤ 2). However, patients with BPTRMI may have an unfavorable outcome.
CONCLUSIONS
Although the clinical features are variable, DWI or ADC map can improve the diagnosis of acute AOP infarction patterns. Acute AOP occlusion requires immediate diagnosis and treatment to obtain more favorable outcome and avoid additional unnecessary procedures.
Topics: Cerebral Infarction; Humans; Magnetic Resonance Imaging; Retrospective Studies; Thalamus; Tomography, X-Ray Computed
PubMed: 35659267
DOI: 10.1186/s12883-022-02735-w -
Internal Medicine (Tokyo, Japan) 2022Objective Left ventricular (LV) thrombus is a rare condition in acute cerebral infarction. The prevalence and features of cerebral infarction with LV thrombus are...
Objective Left ventricular (LV) thrombus is a rare condition in acute cerebral infarction. The prevalence and features of cerebral infarction with LV thrombus are unclear. We explored the features of cerebral infarction due to LV thrombus. Methods In this single-center retrospective study, we investigated consecutive patients with acute ischemic stroke admitted within seven days of the onset who had LV thrombus found by transthoracic echocardiography (TTE). First, we calculated the prevalence of LV thrombus in patients with cardioembolic stroke (CES). Second, we investigated the baseline characteristics, including the TTE findings and features of cerebral infarction due to LV thrombus. Results From June 2012 to January 2019, a total of 5,693 patients were enrolled. Of these, 1,408 (25%) patients were diagnosed with CES. Of these 1,408 patients with CES, 13 (0.9%) had LV thrombus indicated by TTE, with dilative cardiomyopathy, subacute myocardial infarction, and old myocardial infarction present in 1 (8%), 2 (15%), and 10 (77%), respectively. The ejection fraction (EF) was 48.9% (25.3-64.7%). The maximum longitudinal size of LV thrombus was 13.4 (0.97-38.1) mm, and there was no correlation between the size of the LV thrombus and the EF. Regarding the features of cerebrovascular infarction, major vessel occlusion was observed in 10 (77%) patients. Six (46%) patients were found to have good outcomes (modified Rankin Scale 0-2) at 90 days after the onset. Conclusion LV thrombus was seen in 0.9% of patients with CES. Many of the patients with LV thrombus had major vessel occlusion.
Topics: Cerebral Infarction; Humans; Ischemic Stroke; Myocardial Infarction; Retrospective Studies; Thrombosis
PubMed: 36047094
DOI: 10.2169/internalmedicine.8015-21 -
Tidsskrift For Den Norske Laegeforening... Mar 2007Approximately half of all cerebral infarctions are caused by artery-to-artery emboli from atherosclerotic plaques in the aorta and pre- or intracranial arteries. This... (Review)
Review
BACKGROUND
Approximately half of all cerebral infarctions are caused by artery-to-artery emboli from atherosclerotic plaques in the aorta and pre- or intracranial arteries. This review article presents an update on the development of atherosclerotic plaques, and discusses the diagnostic and therapeutic implications of new pathophysiological knowledge of atherosclerosis in relation to cerebral infarction.
MATERIAL AND METHODS
The article is based on our own clinical-neurological experience and publications mainly on intima-media thickness (IMT) and ultrasound in the diagnosis of cerebrovascular disease, identified through a Medline search.
RESULTS
Unstable plaques have a thin and vulnerable capsule, inflammatory cells, high fat content and often intra-plaque bleeding. Calcium deposition and organized fibrous tissue have a stabilizing effect. The development of atherosclerosis and biological characteristics of plaques can be explained by known vascular risk factors and genetic disposition. Ultrasound examination of the aorta and pre-cerebral arteries can be used to assess the degree of atherosclerosis and to provide important information regarding patients' risk of cerebrovascular disease.
INTERPRETATION
New knowledge regarding the pathophysiology of atherosclerosis can improve prediction of a patient's risk for ischemic stroke. This forms the basis for a better and more individualized prophylactic treatment of cerebrovascular disease.
Topics: Atherosclerosis; Carotid Arteries; Cerebral Infarction; Embolism; Endothelium, Vascular; Humans; Risk Factors; Stroke; Ultrasonography
PubMed: 17435812
DOI: No ID Found -
Journal of Healthcare Engineering 2021In recent years, with the progress of population ageing, the incidence of a stroke caused by spontaneous dissection of the cerebral artery also increases with time. In...
In recent years, with the progress of population ageing, the incidence of a stroke caused by spontaneous dissection of the cerebral artery also increases with time. In order to address the health damage caused by a stroke caused by spontaneous dissection of the cerebral artery and to study its effect on human health, this article analyzes the incidence, type, electrocardiogram, and cardiovascular biomarker changes of cerebral infarction through statistical analysis and then discusses cerebral infarction. The pathogenesis and prevention measures of the disease are expected to provide better means for the treatment of cerebral infarction. Based on the case investigation of patients with cerebral infarction caused by spontaneous cerebral artery dissection, a case template was constructed, and a damage assessment matrix was created using a comprehensive quantitative and qualitative analysis method. Experimental results prove that cerebral infarction caused by spontaneous cerebral artery dissection is a great threat to human health, and the fatality rate of patients is extremely high. Enhanced imaging technology is of great help to clinical and image analysis, with a correlation coefficient of 0.87, compared with the other damage rate of cerebral infarction caused by spontaneous cerebral artery dissection which is about 15% higher than that of cerebral infarction caused by different methods. Studies have found that there are great differences in the age of people with cerebral infarction caused by spontaneous cerebral artery dissection, and the patients are generally over 45 years old. This shows that cerebral infarction caused by spontaneous cerebral artery dissection will cause great damage and affect people's health, which requires people's attention.
Topics: Augmented Reality; Cerebral Arteries; Cerebral Infarction; Humans; Image Processing, Computer-Assisted; Middle Aged; Technology
PubMed: 33628405
DOI: 10.1155/2021/6671121 -
Neurological Sciences : Official... Apr 2022The objective of this manuscript is to describe the challenges of Cardio-Cerebral Infarction (CCI) treatment and to highlight the variable approaches in management. CCI... (Review)
Review
The objective of this manuscript is to describe the challenges of Cardio-Cerebral Infarction (CCI) treatment and to highlight the variable approaches in management. CCI is a rare clinical presentation of simultaneous acute ischemic stroke (AIS) and acute myocardial infarction (AMI) and poses a therapeutic challenge for practitioners. Each disease requires timely intervention to prevent irreversible damage; however, optimal management remains unclear. We describe three cases of CCI. All three patients presented with symptomatic left MCA (M1) occlusion, with ST elevation myocardial infarction (STEMI) and left ventricular apical thrombus. Fibrinolysis and mechanical thrombectomy (MT) were discussed in all cases, but only one patient received alteplase (0.9 mg/kg) and none underwent MT. Percutaneous intervention (PCI) was done in only one case. The two patients that did not receive thrombolysis were treated with modified therapeutic heparin (no bolus), and all received antiplatelet therapy. Ultimately, all three patients passed away. CCI poses a clinical challenge for physicians including (1) optimal strategies to enable swift mechanical reperfusion to both the brain and myocardium; (2) difference in dosage of thrombolytics for AIS versus AMI; (3) risk of symptomatic intracerebral hemorrhage following administration of anticoagulation and/or antiplatelet therapy; and (4) caution with use of thrombolytics in the setting of acute STEMI due to the risk of myocardial rupture. In the absence of high quality evidence and clinical guidelines, treatment of CCI is highly individualized.
Topics: Cerebral Infarction; Humans; Ischemic Stroke; Percutaneous Coronary Intervention; Stroke; Treatment Outcome
PubMed: 34590206
DOI: 10.1007/s10072-021-05628-x