Document Detail


Ischemic core and penumbra in human stroke.
MedLine Citation:
PMID:  9880395     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: The ischemic core and penumbra have not been thoroughly characterized after acute cerebral thromboembolic occlusion in humans. Differentiation between areas of potentially viable and irreversibly injured ischemic tissue may facilitate assessment and treatment of stroke patients. METHODS: Cerebral blood flow (CBF) was measured in 20 patients with acute middle cerebral artery (MCA) occlusion between 60 and 360 minutes after stroke onset, with the stable xenon computerized tomography (CT) technique. Threshold displays were generated at a single level, and the percentages of hemisphere with CBF </=6, </=10, 11 to 20, 21 to 30, and >30 cm3. 100 g-1. min-1 were measured. The corresponding images on 12 available follow-up CT scans were similarly assessed to determine the area of final infarct. Comparisons were analyzed with a paired Student's t test and Pearson's correlation coefficient. RESULTS: Discrete and confluent areas of CBF </=20 cm3. 100 g-1. min-1 were identified in all patients, ipsilateral to the symptomatic MCA territory. The average area of CBF </=20 cm3. 100 g-1. min-1 within the ipsilateral hemisphere was 66+/-17% compared with 36+/-12% contralaterally (P<0.001). A difference in the extent of low CBF was due primarily to areas with CBF </=10 cm3. 100 g-1. min-1 (48+/-18% versus 16+/-7%, P<0.001). The area of most severe ipsilateral ischemia (</=6 cm3. 100 g-1. min-1) best corresponded to the final area of infarction (37+/-18% versus 40+/-24%; correlation coefficient, 0.866; P<0.01). The acute ischemic core destined to infarction was not surrounded by a widened rim of moderate ischemia because the area with CBF 11 to 20 cm3. 100 g-1. min-1 was similar bilaterally (19+/-4% versus 20+/-7%, P=0.792, thus not significant). CONCLUSIONS: Our study in acute human stroke involving MCA occlusion indicates that a severely ischemic core (CBF </=6 cm3. 100 g-1. min-1), observed between 1 to 6 hours after stroke onset, corresponds to the cerebral tissue destined to infarction. The ischemic penumbra with flow values between 7 and 20 cm3. 100 g-1. min-1 surrounding the ischemic core is very narrow. Therefore, strategies to improve the outcome of many patients with acute MCA occlusion must either include interventions to reverse the ischemic process within a few minutes of onset or increase the cerebral tolerance of ischemia and thereby prolong the potential therapeutic window.
Authors:
A M Kaufmann; A D Firlik; M B Fukui; L R Wechsler; C A Jungries; H Yonas
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  30     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-02-08     Completed Date:  1999-02-08     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  93-9     Citation Subset:  IM    
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Alberta, Canada. anthony.kaufmann@crha-health.ab.ca
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Arterial Occlusive Diseases / physiopathology,  radiography
Brain Ischemia / physiopathology,  radiography*
Cerebral Infarction / physiopathology,  radiography
Cerebrovascular Circulation / physiology*
Cerebrovascular Disorders / physiopathology,  radiography*
Female
Humans
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed / methods*
Xenon / diagnostic use
Chemical
Reg. No./Substance:
7440-63-3/Xenon
Comments/Corrections
Comment In:
Stroke. 1999 May;30(5):1150-3   [PMID:  10229761 ]

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