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Čivrný J, Tomáš D, Černá M. MRI of cerebral oedema in ischaemic stroke and its current use in routine clinical practice. Neuroradiology 2024; 66:305-315. [PMID: 38102491 PMCID: PMC10859334 DOI: 10.1007/s00234-023-03262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
Currently, with the knowledge of the role of collateral circulation in the development of cerebral ischaemia, traditional therapeutic windows are being prolonged, with time not being the only criterion. Instead, a more personalised approach is applied to select additional patients who might benefit from active treatment. This review briefly describes the current knowledge of the pathophysiology of the development of early ischaemic changes, the capabilities of MRI to depict such changes, and the basics of the routinely used imaging techniques broadly available for the assessment of individual phases of cerebral ischaemia, and summarises the possible clinical use of routine MR imaging, including patient selection for active treatment and assessment of the outcome on the basis of imaging.
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Affiliation(s)
- Jakub Čivrný
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic.
- Fakultní nemocnice Olomouc, Radiologická klinika, Zdravotníků 248/7, 779 00, Olomouc, Czech Republic.
| | - Dorňák Tomáš
- Fakultní nemocnice Olomouc, Radiologická klinika, Zdravotníků 248/7, 779 00, Olomouc, Czech Republic
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Marie Černá
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic
- Fakultní nemocnice Olomouc, Radiologická klinika, Zdravotníků 248/7, 779 00, Olomouc, Czech Republic
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2
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Diprose WK, Rao A, Ghate K, Dyer Z, Campbell D, Almekhlafi M, Barber PA. Penumbral cooling in ischemic stroke with intraarterial, intravenous or active conductive head cooling: A thermal modeling study. J Cereb Blood Flow Metab 2024; 44:66-76. [PMID: 37734834 PMCID: PMC10905634 DOI: 10.1177/0271678x231203025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/23/2023]
Abstract
In ischemic stroke, selectively cooling the ischemic penumbra might lead to neuroprotection while avoiding systemic complications. Because penumbral tissue has reduced cerebral blood flow and in vivo brain temperature measurement remains challenging, the effect of different methods of therapeutic hypothermia on penumbral temperature are unknown. We used the COMSOL Multiphysics® software to model a range of cases of therapeutic hypothermia in ischemic stroke. Four ischemic stroke models were developed with ischemic core and/or penumbra volumes between 33-300 mL. Four experiments were performed on each model, including no cooling, and intraarterial, intravenous, and active conductive head cooling. The steady-state temperature of the non-ischemic brain, ischemic penumbra, and ischemic core without cooling was 37.3 °C, 37.5-37.8 °C, and 38.9-39.4 °C respectively. Intraarterial, intravenous and active conductive head cooling reduced non-ischemic brain temperature by 4.3 °C, 2.1 °C, and 0.7-0.8 °C respectively. Intraarterial, intravenous and head cooling reduced the temperature of the ischemic penumbra by 3.9-4.3 °C, 1.9-2.1 °C, and 1.2-3.4 °C respectively. Active conductive head cooling was the only method to selectively reduce penumbral temperature. Clinical studies that measure brain temperature in ischemic stroke patients undergoing therapeutic hypothermia are required to validate these hypothesis-generating findings.
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Affiliation(s)
- William K Diprose
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Avinash Rao
- Department of Engineering, Victoria University of Wellington, Wellington, New Zealand
| | - Kaustubha Ghate
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Zoe Dyer
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Doug Campbell
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - P Alan Barber
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
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Baranovicova E, Kalenska D, Kaplan P, Kovalska M, Tatarkova Z, Lehotsky J. Blood and Brain Metabolites after Cerebral Ischemia. Int J Mol Sci 2023; 24:17302. [PMID: 38139131 PMCID: PMC10743907 DOI: 10.3390/ijms242417302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
The study of an organism's response to cerebral ischemia at different levels is essential to understanding the mechanism of the injury and protection. A great interest is devoted to finding the links between quantitative metabolic changes and post-ischemic damage. This work aims to summarize the outcomes of the most studied metabolites in brain tissue-lactate, glutamine, GABA (4-aminobutyric acid), glutamate, and NAA (N-acetyl aspartate)-regarding their biological function in physiological conditions and their role after cerebral ischemia/reperfusion. We focused on ischemic damage and post-ischemic recovery in both experimental-including our results-as well as clinical studies. We discuss the role of blood glucose in view of the diverse impact of hyperglycemia, whether experimentally induced, caused by insulin resistance, or developed as a stress response to the cerebral ischemic event. Additionally, based on our and other studies, we analyze and critically discuss post-ischemic alterations in energy metabolites and the elevation of blood ketone bodies observed in the studies on rodents. To complete the schema, we discuss alterations in blood plasma circulating amino acids after cerebral ischemia. So far, no fundamental brain or blood metabolite(s) has been recognized as a relevant biological marker with the feasibility to determine the post-ischemic outcome or extent of ischemic damage. However, studies from our group on rats subjected to protective ischemic preconditioning showed that these animals did not develop post-ischemic hyperglycemia and manifested a decreased metabolic infringement and faster metabolomic recovery. The metabolomic approach is an additional tool for understanding damaging and/or restorative processes within the affected brain region reflected in the blood to uncover the response of the whole organism via interorgan metabolic communications to the stressful cerebral ischemic challenge.
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Affiliation(s)
- Eva Baranovicova
- Biomedical Center BioMed, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia;
| | - Dagmar Kalenska
- Department of Anatomy, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia
| | - Peter Kaplan
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia (Z.T.)
| | - Maria Kovalska
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia
| | - Zuzana Tatarkova
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia (Z.T.)
| | - Jan Lehotsky
- Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Mala Hora 4, 036 01 Martin, Slovakia (Z.T.)
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Tsai HJ, Wong YS, Ong CT. Clinical course and risk factors for sleep disturbance in patients with ischemic stroke. PLoS One 2022; 17:e0277309. [PMID: 36346797 PMCID: PMC9642877 DOI: 10.1371/journal.pone.0277309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Studies on insomnia in patients with ischemic stroke, particularly in the acute phase, are limited. The proportion of patients with sleep disturbance during the acute stroke period who are likely to develop insomnia in subacute and chronic stages of stroke is unknown. This study aimed to investigate the risk factors for sleep disturbance and the clinical course of the disease in patients with acute ischemic stroke. Methods This prospective observational study included patients diagnosed with ischemic stroke between July 1, 2020, and October 31, 2021. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for insomnia and the eight-item Athens Insomnia Scale (CAIS-8) were used to diagnose insomnia. Beck Depression Inventory (BDI) was applied to evaluate the mood of patients. Patient reported their sleeping conditions, before stroke onset and during the acute (within 7 days) and chronic (3 months after presentation) stroke periods. Results In total, 195 patients with ischemic stroke were included in this study. Of these, 34.3% (67), 37.4% (73), and 29.7% (58) presented with sleep disturbance before stroke onset and during the acute and chronic stroke periods, respectively. Of the 128 patients without insomnia before stroke onset, 15.6% (20/128) presented with insomnia symptoms 3 months after stroke onset. Moreover, 13 (12.7%) of the 102 patients without sleep disturbance during the acute stroke period developed insomnia 3 months after stroke onset. Of the 67 patients with insomnia before stroke onset 29 (43.3%) did not develop the condition 3 months after stroke onset. A higher risk of sleep disturbance was associated with atrial fibrillation, hypertension, and mood disturbance in the acute stroke period, and a higher risk of insomnia was associated with low education and mood disturbance in the chronic stroke period. Conclusion The prevalence rates of sleep disturbance before and during the acute and chronic stroke periods were 34.3%, 37.4%, and 29.7%, respectively. The incidence of stroke-related insomnia was 15.6%. Patients with insomnia before stroke may recover after the stroke. Atrial fibrillation, hypertension, and mood disturbance were associated with a higher risk of sleep disturbance in the acute stroke period, whereas low education and mood disturbance were associated with insomnia in the chronic stroke period.
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Affiliation(s)
- Hui-Ju Tsai
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- * E-mail:
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Liu L, Zhang P, Liang G, Xiong S, Wang J, Zheng G. A spatiotemporal correlation deep learning network for brain penumbra disease. Neurocomputing 2022. [DOI: 10.1016/j.neucom.2022.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Daftari Besheli L, Ahmed A, Hamam O, Luna L, Sun LR, Urrutia V, Hillis AE, Tekes-Brady A, Yedavalli V. Arterial Spin Labeling technique and clinical applications of the intracranial compartment in stroke and stroke mimics - A case-based review. Neuroradiol J 2022; 35:437-453. [PMID: 35635512 PMCID: PMC9437493 DOI: 10.1177/19714009221098806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Magnetic resonance imaging perfusion (MRP) techniques can improve the selection of acute ischemic stroke patients for treatment by estimating the salvageable area of decreased perfusion, that is, penumbra. Arterial spin labeling (ASL) is a noncontrast MRP technique that is used to assess cerebral blood flow without the use of intravenous gadolinium contrast. Thus, ASL is of particular interest in stroke imaging. This article will review clinical applications of ASL in stroke such as assessment of the core infarct and penumbra, localization of the vascular occlusion, and collateral status. Given the nonspecific symptoms that patients can present with, differentiating between stroke and a stroke mimic is a diagnostic dilemma. ASL not only helps in differentiating stroke from stroke mimic but also can be used to specify the exact mimic when used in conjunction with the symptomatology and structural imaging. In addition to a case-based overview of clinical applications of the ASL in stroke and stroke mimics in this article, the more commonly used ASL labeling techniques as well as emerging ASL techniques, future developments, and limitations will be reviewed.
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Affiliation(s)
| | - Amara Ahmed
- Florida State University College of
Medicine, Tallahassee, FL, USA
| | - Omar Hamam
- Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | - Licia Luna
- Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | - Lisa R Sun
- Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | | | - Argye E Hillis
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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Usmanov ES, Chubarova MA, Saidov SK. Emerging Trends in the Use of Therapeutic Hypothermia as a Method for Neuroprotection in Brain Damage (Review). Sovrem Tekhnologii Med 2021; 12:94-104. [PMID: 34796010 PMCID: PMC8596265 DOI: 10.17691/stm2020.12.5.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
The review analyzes current clinical studies on the use of therapeutic hypothermia as a neuroprotective method for treatment of brain damage. This method yields good outcomes in patients with acute brain injuries and chronic critical conditions. There has been shown the interest of researchers in studying the preventive potential of therapeutic hypothermia in secondary neuronal damage. There has been described participation of new molecules producing positive effect on tissues and cells of the central nervous system - proteins and hormones of cold stress - in the mechanisms of neuroprotection in the brain. The prospects of using targeted temperature management in treatment of brain damage are considered.
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Affiliation(s)
- E Sh Usmanov
- Researcher, Laboratory of Clinical Neurophysiology; Federal Clinical Research Centre for Intensive Care Medicine and Rehabilitology, 777 Lytkino Village, Solnechnogorsk District, Moscow Region, 141534, Russia
| | - M A Chubarova
- Junior Researcher, Laboratory of Clinical Neurophysiology; Federal Clinical Research Centre for Intensive Care Medicine and Rehabilitology, 777 Lytkino Village, Solnechnogorsk District, Moscow Region, 141534, Russia
| | - Sh Kh Saidov
- Senior Researcher, Laboratory of Clinical Neurophysiology Federal Clinical Research Centre for Intensive Care Medicine and Rehabilitology, 777 Lytkino Village, Solnechnogorsk District, Moscow Region, 141534, Russia
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Liu J, Lin C, Minuti A, Lipton M. Arterial spin labeling compared to dynamic susceptibility contrast MR perfusion imaging for assessment of ischemic penumbra: A systematic review. J Neuroimaging 2021; 31:1067-1076. [PMID: 34388271 DOI: 10.1111/jon.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/23/2021] [Accepted: 07/17/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Dynamic susceptibility contrast (DSC) MR imaging is commonly used to estimate penumbra size in acute ischemic stroke; this technique relies on the administration of gadolinium contrast, which has limited use in certain populations, such as those with impaired renal function or allergies. Arterial spin labeling (ASL) is a relatively new technique that can provide information on cerebral perfusion without need for exogenous contrast agents. This systematic review examines published studies that specifically compared ASL to DSC for assessment of ischemic penumbra. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library for papers which compared ASL with DSC for assessment of ischemic penumbra in acute ischemic stroke among adult human populations. Two independent reviewers screened studies using predefined inclusion and exclusion criteria. Study characteristics and findings regarding the utility of ASL compared to DSC for identification of penumbra were then extracted and anlyzed for results and risk of bias. RESULTS Seventeen articles met inclusion and exclusion criteria. Studies compared ASL with DSC on a range of metrics (hypoperfusion, hyperperfusion, mismatch, and reperfusion). Most studies concluded that agreement of ASL with DSC was moderate to very high. A small subset of studies found discrepancy in agreement of ASL with DSC for size or location of perfusion abnormalities. A heterogeneity of perfusion parameters studied for DSC was noted, along with the need for more standardization of research methods. CONCLUSION ASL shows moderate to high agreement with DSC for detection of penumbra among ischemic stroke patients.
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Affiliation(s)
- Jinyuan Liu
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Christopher Lin
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Aurelia Minuti
- The D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.,The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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9
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Ponsaerts L, Alders L, Schepers M, de Oliveira RMW, Prickaerts J, Vanmierlo T, Bronckaers A. Neuroinflammation in Ischemic Stroke: Inhibition of cAMP-Specific Phosphodiesterases (PDEs) to the Rescue. Biomedicines 2021; 9:703. [PMID: 34206420 PMCID: PMC8301462 DOI: 10.3390/biomedicines9070703] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/27/2022] Open
Abstract
Ischemic stroke is caused by a thromboembolic occlusion of a major cerebral artery, with the impaired blood flow triggering neuroinflammation and subsequent neuronal damage. Both the innate immune system (e.g., neutrophils, monocytes/macrophages) in the acute ischemic stroke phase and the adaptive immune system (e.g., T cells, B cells) in the chronic phase contribute to this neuroinflammatory process. Considering that the available therapeutic strategies are insufficiently successful, there is an urgent need for novel treatment options. It has been shown that increasing cAMP levels lowers neuroinflammation. By inhibiting cAMP-specific phosphodiesterases (PDEs), i.e., PDE4, 7, and 8, neuroinflammation can be tempered through elevating cAMP levels and, thereby, this can induce an improved functional recovery. This review discusses recent preclinical findings, clinical implications, and future perspectives of cAMP-specific PDE inhibition as a novel research interest for the treatment of ischemic stroke. In particular, PDE4 inhibition has been extensively studied, and is promising for the treatment of acute neuroinflammation following a stroke, whereas PDE7 and 8 inhibition more target the T cell component. In addition, more targeted PDE4 gene inhibition, or combined PDE4 and PDE7 or 8 inhibition, requires more extensive research.
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Affiliation(s)
- Laura Ponsaerts
- Biomedical Research Institute, Hasselt University, 3500 Hasselt, Belgium; (L.P.); (L.A.); (M.S.)
- European Graduate School of Neuroscience (EURON), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Lotte Alders
- Biomedical Research Institute, Hasselt University, 3500 Hasselt, Belgium; (L.P.); (L.A.); (M.S.)
- European Graduate School of Neuroscience (EURON), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Melissa Schepers
- Biomedical Research Institute, Hasselt University, 3500 Hasselt, Belgium; (L.P.); (L.A.); (M.S.)
- European Graduate School of Neuroscience (EURON), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
- Department Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | | | - Jos Prickaerts
- European Graduate School of Neuroscience (EURON), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
- Department Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Tim Vanmierlo
- Biomedical Research Institute, Hasselt University, 3500 Hasselt, Belgium; (L.P.); (L.A.); (M.S.)
- European Graduate School of Neuroscience (EURON), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
- Department Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Annelies Bronckaers
- Biomedical Research Institute, Hasselt University, 3500 Hasselt, Belgium; (L.P.); (L.A.); (M.S.)
- European Graduate School of Neuroscience (EURON), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
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Subedi L, Gaire BP. Phytochemicals as regulators of microglia/macrophages activation in cerebral ischemia. Pharmacol Res 2021; 165:105419. [DOI: 10.1016/j.phrs.2021.105419] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/16/2020] [Accepted: 01/02/2021] [Indexed: 12/12/2022]
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Cellular and Molecular Mechanisms of R/S-Roscovitine and CDKs Related Inhibition under Both Focal and Global Cerebral Ischemia: A Focus on Neurovascular Unit and Immune Cells. Cells 2021; 10:cells10010104. [PMID: 33429982 PMCID: PMC7827530 DOI: 10.3390/cells10010104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022] Open
Abstract
Ischemic stroke is the second leading cause of death worldwide. Following ischemic stroke, Neurovascular Unit (NVU) inflammation and peripheral leucocytes infiltration are major contributors to the extension of brain lesions. For a long time restricted to neurons, the 10 past years have shown the emergence of an increasing number of studies focusing on the role of Cyclin-Dependent Kinases (CDKs) on the other cells of NVU, as well as on the leucocytes. The most widely used CDKs inhibitor, (R)-roscovitine, and its (S) isomer both decreased brain lesions in models of global and focal cerebral ischemia. We previously showed that (S)-roscovitine acted, at least, by modulating NVU response to ischemia. Interestingly, roscovitine was shown to decrease leucocytes-mediated inflammation in several inflammatory models. Specific inhibition of roscovitine majors target CDK 1, 2, 5, 7, and 9 showed that these CDKs played key roles in inflammatory processes of NVU cells and leucocytes after brain lesions, including ischemic stroke. The data summarized here support the investigation of roscovitine as a potential therapeutic agent for the treatment of ischemic stroke, and provide an overview of CDK 1, 2, 5, 7, and 9 functions in brain cells and leucocytes during cerebral ischemia.
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Liao S, Apaijai N, Chattipakorn N, Chattipakorn SC. The possible roles of necroptosis during cerebral ischemia and ischemia / reperfusion injury. Arch Biochem Biophys 2020; 695:108629. [PMID: 33068524 DOI: 10.1016/j.abb.2020.108629] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/03/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Cell death is a process consequential to cerebral ischemia and cerebral ischemia/reperfusion (I/R) injury. Recent evidence suggest that necroptosis has been involved in the pathogenesis of ischemic brain injury. The mechanism of necroptosis is initiated by an activation of inflammatory receptors including tumor necrosis factor, toll like receptor, and fas ligands. The signals activate the receptor-interacting protein kinase (RIPK) 1, 3, and a mixed-lineage kinase domain-like pseudokinase (MLKL) to instigate necroptosis. RIPK1 inhibitor, necrostatin-1, was developed, and dramatically reduced brain injury following cerebral ischemia in mice. Consequently, necroptosis could be a novel therapeutic target for stroke, which aims to reduce long-term adverse outcomes after cerebral ischemia. Several studies have been conducted to test the roles of necroptosis on cerebral ischemia and cerebral I/R injury, and the efficacy of necrostatin-1 has been tested in those models. Evidence regarding the roles of necroptosis and the effects of necrostatin-1, from in vitro and in vivo studies, has been summarized and discussed. In addition, other therapeutic managements, involving in necroptosis, are also included in this review. We believe that the insights from this review might clarify the clinical perspective and challenges involved in future stroke treatment by targeting the necroptosis pathway.
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Affiliation(s)
- Suchan Liao
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nattayaporn Apaijai
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Li Z, Lindner DP, Bishop NM, Cipolla MJ. ACE (Angiotensin-Converting Enzyme) Inhibition Reverses Vasoconstriction and Impaired Dilation of Pial Collaterals in Chronic Hypertension. Hypertension 2020; 76:226-235. [PMID: 32418498 DOI: 10.1161/hypertensionaha.119.14315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Leptomeningeal anastomoses (LMAs) are pial collaterals that perfuse the penumbra and important for stroke outcome. We previously showed LMAs from SHRs (spontaneously hypertensive rats) were vasoconstricted compared with normotensive Wistar rats. Here, we investigated mechanisms by which hypertension causes LMA vasoconstriction. SHRs were treated with the ACE (angiotensin-converting enzyme) inhibitor captopril, an Ang II (angiotensin II)-independent antihypertensive agent hydralazine, or vehicle for 5 weeks in drinking water (n=8/group). A group of Wistar rats (n=8) had regular drinking water served as controls. Blood pressure was measured twice weekly by tail-cuff. LMAs were isolated and studied under pressurized conditions. Vasoreactivity of LMAs, including myogenic responses, reactivity to Rho-kinase inhibitor Y-27632, and nitric oxide were measured. Both captopril and hydralazine lowered blood pressure in SHRs similar to Wistar. However, only captopril normalized LMA increased tone compared with untreated SHRs (15±2% versus 50±3%; P<0.01) that was similar to Wistar (16±2%) but not hydralazine (38±6%; P>0.05). Vasodilatory response of LMAs to Y-27632 was impaired in SHRs compared with Wistar (28±3% versus 81±4%; P<0.01) that was restored by captopril (84±5%; P<0.01) and partially hydralazine (59±4%). LMAs from all groups constricted similarly to NOS (NO synthase) inhibition; however, the vasodilatory response of LMAs to the nitric oxide donor sodium nitroprusside was impaired in SHRs compared with Wistar rats (29±4% versus 80±2%; P<0.01) that was restored by captopril (84±4%; P<0.01), not hydralazine (38±8%; P>0.05). These results suggest that ACE inhibition during chronic hypertension reversed vascular dysfunction and hyperconstriction of LMAs that could improve stroke outcome by increasing collateral perfusion.
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Affiliation(s)
- Zhaojin Li
- From the Department of Neurological Sciences (Z.L., D.P.L., M.J.C.), University of Vermont Robert Larner College of Medicine, Burlington
| | - Devon P Lindner
- From the Department of Neurological Sciences (Z.L., D.P.L., M.J.C.), University of Vermont Robert Larner College of Medicine, Burlington
| | - Nicole M Bishop
- Department of Pathology (N.M.B.), University of Vermont Robert Larner College of Medicine, Burlington
| | - Marilyn J Cipolla
- From the Department of Neurological Sciences (Z.L., D.P.L., M.J.C.), University of Vermont Robert Larner College of Medicine, Burlington.,Department of Obstetrics, Gynecology, and Reproductive Sciences (M.J.C.), University of Vermont Robert Larner College of Medicine, Burlington.,Department of Pharmacology (M.J.C.), University of Vermont Robert Larner College of Medicine, Burlington
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14
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Liu L, Wu FX, Wang J. Efficient multi-kernel DCNN with pixel dropout for stroke MRI segmentation. Neurocomputing 2019. [DOI: 10.1016/j.neucom.2019.03.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Zheng T, Jiang H, Jin R, Zhao Y, Bai Y, Xu H, Chen Y. Ginsenoside Rg1 attenuates protein aggregation and inflammatory response following cerebral ischemia and reperfusion injury. Eur J Pharmacol 2019; 853:65-73. [DOI: 10.1016/j.ejphar.2019.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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16
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Jackson TC, Kochanek PM. A New Vision for Therapeutic Hypothermia in the Era of Targeted Temperature Management: A Speculative Synthesis. Ther Hypothermia Temp Manag 2019; 9:13-47. [PMID: 30802174 PMCID: PMC6434603 DOI: 10.1089/ther.2019.0001] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Three decades of animal studies have reproducibly shown that hypothermia is profoundly cerebroprotective during or after a central nervous system (CNS) insult. The success of hypothermia in preclinical acute brain injury has not only fostered continued interest in research on the classic secondary injury mechanisms that are prevented or blunted by hypothermia but has also sparked a surge of new interest in elucidating beneficial signaling molecules that are increased by cooling. Ironically, while research into cold-induced neuroprotection is enjoying newfound interest in chronic neurodegenerative disease, conversely, the scope of the utility of therapeutic hypothermia (TH) across the field of acute brain injury is somewhat controversial and remains to be fully defined. This has led to the era of Targeted Temperature Management, which emphasizes a wider range of temperatures (33–36°C) showing benefit in acute brain injury. In this comprehensive review, we focus on our current understandings of the novel neuroprotective mechanisms activated by TH, and discuss the critical importance of developmental age germane to its clinical efficacy. We review emerging data on four cold stress hormones and three cold shock proteins that have generated new interest in hypothermia in the field of CNS injury, to create a framework for new frontiers in TH research. We make the case that further elucidation of novel cold responsive pathways might lead to major breakthroughs in the treatment of acute brain injury, chronic neurological diseases, and have broad potential implications for medicines of the distant future, including scenarios such as the prevention of adverse effects of long-duration spaceflight, among others. Finally, we introduce several new phrases that readily summarize the essence of the major concepts outlined by this review—namely, Ultramild Hypothermia, the “Responsivity of Cold Stress Pathways,” and “Hypothermia in a Syringe.”
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Affiliation(s)
- Travis C Jackson
- 1 John G. Rangos Research Center, UPMC Children's Hospital of Pittsburgh, Safar Center for Resuscitation Research, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania.,2 Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Patrick M Kochanek
- 1 John G. Rangos Research Center, UPMC Children's Hospital of Pittsburgh, Safar Center for Resuscitation Research, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania.,2 Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
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17
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He L, Baker WB, Milej D, Kavuri VC, Mesquita RC, Busch DR, Abramson K, Jiang JY, Diop M, St. Lawrence K, Amendolia O, Quattrone F, Balu R, Kofke WA, Yodh AG. Noninvasive continuous optical monitoring of absolute cerebral blood flow in critically ill adults. NEUROPHOTONICS 2018; 5:045006. [PMID: 30480039 PMCID: PMC6251207 DOI: 10.1117/1.nph.5.4.045006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/29/2018] [Indexed: 05/18/2023]
Abstract
We investigate a scheme for noninvasive continuous monitoring of absolute cerebral blood flow (CBF) in adult human patients based on a combination of time-resolved dynamic contrast-enhanced near-infrared spectroscopy (DCE-NIRS) and diffuse correlation spectroscopy (DCS) with semi-infinite head model of photon propogation. Continuous CBF is obtained via calibration of the DCS blood flow index (BFI) with absolute CBF obtained by intermittent intravenous injections of the optical contrast agent indocyanine green. A calibration coefficient ( γ ) for the CBF is thus determined, permitting conversion of DCS BFI to absolute blood flow units at all other times. A study of patients with acute brain injury ( N = 7 ) is carried out to ascertain the stability of γ . The patient-averaged DCS calibration coefficient across multiple monitoring days and multiple patients was determined, and good agreement between the two calibration coefficients measured at different times during single monitoring days was found. The patient-averaged calibration coefficient of 1.24 × 10 9 ( mL / 100 g / min ) / ( cm 2 / s ) was applied to previously measured DCS BFI from similar brain-injured patients; in this case, absolute CBF was underestimated compared with XeCT, an effect we show is primarily due to use of semi-infinite homogeneous models of the head.
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Affiliation(s)
- Lian He
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
- Address all correspondence to: Lian He, E-mail:
| | - Wesley B. Baker
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Daniel Milej
- Western University, Department of Medical Biophysics, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Division, London, Ontario, Canada
| | - Venkaiah C. Kavuri
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | | | - David R. Busch
- University of Texas Southwestern, Department of Neurology and Neurotherapeutics, Dallas, Texas, United States
- University of Texas Southwestern, Department of Anesthesiology and Pain Management, Dallas, Texas, United States
| | - Kenneth Abramson
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Jane Y. Jiang
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Mamadou Diop
- Western University, Department of Medical Biophysics, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Division, London, Ontario, Canada
| | - Keith St. Lawrence
- Western University, Department of Medical Biophysics, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Division, London, Ontario, Canada
| | - Olivia Amendolia
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Francis Quattrone
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Ramani Balu
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - W. Andrew Kofke
- University of Pennsylvania, Department of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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18
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Sifat AE, Vaidya B, Villalba H, Albekairi TH, Abbruscato TJ. Neurovascular unit transport responses to ischemia and common coexisting conditions: smoking and diabetes. Am J Physiol Cell Physiol 2018; 316:C2-C15. [PMID: 30207783 DOI: 10.1152/ajpcell.00187.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transporters at the neurovascular unit (NVU) are vital for the regulation of normal brain physiology via ion, water, and nutrients movement. In ischemic stroke, the reduction of cerebral blood flow causes several complex pathophysiological changes in the brain, one of which includes alterations of the NVU transporters, which can exacerbate stroke outcome by increased brain edema (by altering ion, water, and glutamate transporters), altered energy metabolism (by altering glucose transporters), and enhanced drug toxicity (by altering efflux transporters). Smoking and diabetes are common risk factors as well as coexisting conditions in ischemic stroke that are also reported to change the expression and function of NVU transporters. Coexistence of these conditions could cause an additive effect in terms of the alterations of brain transporters that might lead to worsened ischemic stroke prognosis and recovery. In this review, we have discussed the effects of ischemic stroke, smoking, and diabetes on some essential NVU transporters and how the simultaneous presence of these conditions can affect the clinical outcome after an ischemic episode. Further scientific investigations are required to elucidate changes in NVU transport in cerebral ischemia, which can lead to better, personalized therapeutic interventions tailor-made for these comorbid conditions.
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Affiliation(s)
- Ali E Sifat
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Bhuvaneshwar Vaidya
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Heidi Villalba
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Thamer H Albekairi
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
| | - Thomas J Abbruscato
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center , Amarillo, Texas
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19
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Bernstock JD, Ye DG, Griffin A, Lee YJ, Lynch J, Latour LL, Friedman GK, Maric D, Hallenbeck JM. Cerebral Ischemia Increases Small Ubiquitin-Like Modifier Conjugation within Human Penumbral Tissue: Radiological-Pathological Correlation. Front Neurol 2018; 8:738. [PMID: 29375471 PMCID: PMC5770374 DOI: 10.3389/fneur.2017.00738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022] Open
Abstract
Posttranslational modification by small ubiquitin-like modifier (SUMO) regulates myriad physiological processes within cells and has been demonstrated to be highly activated in murine brains after cerebral ischemia. Numerous in vitro and murine in vivo studies have demonstrated that this increased SUMO conjugation is an endogenous neuroprotective stress response that has potential in being leveraged to develop novel therapies for ischemic stroke. However, SUMO activation has not yet been studied in poststroke human brains, presenting a clear limitation in translating experimental successes in murine models to human patients. Accordingly, here, we present a case wherein the brain tissue of a stroke patient (procured shortly after death) was processed by multiplex immunohistochemistry to investigate SUMO activation.
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Affiliation(s)
- Joshua D Bernstock
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.,Department of Clinical Neurosciences, Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
| | - Daniel G Ye
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Allison Griffin
- Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Yang-Ja Lee
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - John Lynch
- Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Lawrence L Latour
- Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Gregory K Friedman
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dragan Maric
- Flow and Imaging Cytometry Core Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - John M Hallenbeck
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
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20
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Johnson U, Engquist H, Howells T, Nilsson P, Ronne-Engström E, Lewén A, Rostami E, Enblad P. Bedside Xenon-CT Shows Lower CBF in SAH Patients with Impaired CBF Pressure Autoregulation as Defined by Pressure Reactivity Index (PRx). Neurocrit Care 2017; 25:47-55. [PMID: 26842717 DOI: 10.1007/s12028-016-0240-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is a disease with a high rate of unfavorable outcome, often related to delayed cerebral ischemia (DCI), i.e., ischemic injury that develops days-weeks after onset, with a multifactorial etiology. Disturbances in cerebral pressure autoregulation, the ability to maintain a steady cerebral blood flow (CBF), despite fluctuations in systemic blood pressure, have been suggested to play a role in the development of DCI. Pressure reactivity index (PRx) is a well-established measure of cerebral pressure autoregulation that has been used to study traumatic brain injury, but not extensively in SAH. OBJECTIVE To study the relation between PRx and CBF in SAH patients, and to examine if PRx can be used to predict DCI. METHODS Retrospective analysis of prospectively collected data. PRx was calculated as the correlation coefficient between mean arterial blood pressure (MABP) and intracranial pressure (ICP) in a 5 min moving window. CBF was measured using bedside Xenon-CT (Xe-CT). DCI was diagnosed clinically. RESULTS 47 poor-grade mechanically ventilated patients were studied. Patients with disturbed pressure autoregulation (high PRx values) had lower CBF, as measured by bedside Xe-CT; both in the early (day 0-3) and late (day 4-14) acute phase of the disease. PRx did not differ significantly between patients who developed DCI or not. CONCLUSION In mechanically ventilated and sedated SAH patients, high PRx (more disturbed CBF pressure autoregulation) is associated with low CBF, both day 0-3 and day 4-14 after onset. The role of PRx as a monitoring tool in SAH patients needs further studying.
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Affiliation(s)
- Ulf Johnson
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden. .,Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | - Henrik Engquist
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.,Department of Surgical Sciences/Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Tim Howells
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Pelle Nilsson
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden
| | | | - Anders Lewén
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Elham Rostami
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden
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21
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Johnson U, Engquist H, Lewén A, Howells T, Nilsson P, Ronne-Engström E, Rostami E, Enblad P. Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP. Acta Neurochir (Wien) 2017; 159:1065-1071. [PMID: 28361248 PMCID: PMC5425502 DOI: 10.1007/s00701-017-3139-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/27/2017] [Indexed: 01/23/2023]
Abstract
Background Cerebral pressure autoregulation can be quantified with the pressure reactivity index (PRx), based on the correlation between blood pressure and intracranial pressure. Using PRx optimal cerebral perfusion pressure (CPPopt) can be calculated, i.e., the level of CPP where autoregulation functions best. The relation between cerebral blood flow (CBF) and CPPopt has not been examined. The objective was to assess to which extent CPPopt can be calculated in SAH patients and to investigate CPPopt in relation to CBF. Methods Retrospective study of prospectively collected data. CBF was measured bedside with Xenon-enhanced CT (Xe-CT). The difference between actual CPP and CPPopt was calculated (CPP∆). Correlations between CPP∆ and CBF parameters were calculated with Spearman’s rank order correlation coefficient (rho). Separate calculations were done using all patients (day 0–14 after onset) as well as in two subgroups (day 0–3 and day 4–14). Results Eighty-two patients with 145 Xe-CT scans were studied. Automated calculation of CPPopt was possible in adjunct to 60% of the Xe-CT scans. Actual CPP < CPPopt was associated with higher numbers of low-flow regions (CBF <10 ml/100 g/min) in both the early phase (day 0–3, n = 39, Spearman’s rho = −0.38, p = 0.02) and late acute phase of the disease (day 4–14, n = 35, Spearman’s rho = −0.39, p = 0.02). CPP level per se was not associated with CBF. Conclusions Calculation of CPPopt is possible in a majority of patients with severe SAH. Actual CPP below CPPopt is associated with low CBF.
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Affiliation(s)
- Ulf Johnson
- Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden.
- Department of Surgical sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | - Henrik Engquist
- Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden
- Department of Surgical sciences/Anaesthesia and Intensive care, Uppsala University, Uppsala, Sweden
| | - Anders Lewén
- Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden
| | - Tim Howells
- Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden
| | - Pelle Nilsson
- Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden
| | | | - Elham Rostami
- Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden
| | - Per Enblad
- Department of Neuroscience/Neurosurgery, Uppsala University, S-75185, Uppsala, Sweden
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22
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Babadjouni RM, Walcott BP, Liu Q, Tenser MS, Amar AP, Mack WJ. Neuroprotective delivery platforms as an adjunct to mechanical thrombectomy. Neurosurg Focus 2017; 42:E4. [PMID: 28366053 DOI: 10.3171/2017.1.focus16514] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite the success of numerous neuroprotective strategies in animal and preclinical stroke models, none have effectively translated to clinical medicine. A multitude of influences are likely responsible. Two such factors are inefficient recanalization strategies for large vessel occlusions and suboptimal delivery methods/platforms for neuroprotective agents. The recent endovascular stroke trials have established a new paradigm for large vessel stroke treatment. The associated advent of advanced mechanical revascularization devices and new stroke technologies help address each of these existing gaps. A strategy combining effective endovascular revascularization with administration of neuroprotective therapies is now practical and could have additive, if not synergistic, effects. This review outlines past and current neuroprotective strategies assessed in acute stroke trials. The discussion focuses on delivery platforms and their potential applicability to endovascular stoke treatment.
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Affiliation(s)
| | - Brian P Walcott
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Matthew S Tenser
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arun P Amar
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - William J Mack
- Zilkha Neurogenetic Institute and.,Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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23
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Brzica H, Abdullahi W, Ibbotson K, Ronaldson PT. Role of Transporters in Central Nervous System Drug Delivery and Blood-Brain Barrier Protection: Relevance to Treatment of Stroke. J Cent Nerv Syst Dis 2017; 9:1179573517693802. [PMID: 28469523 PMCID: PMC5392046 DOI: 10.1177/1179573517693802] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/22/2017] [Indexed: 01/01/2023] Open
Abstract
Ischemic stroke is a leading cause of morbidity and mortality in the United States. The only approved pharmacologic treatment for ischemic stroke is thrombolysis via recombinant tissue plasminogen activator (r-tPA). A short therapeutic window and serious adverse events (ie, hemorrhage, excitotoxicity) greatly limit r-tPA therapy, which indicates an essential need to develop novel stroke treatment paradigms. Transporters expressed at the blood-brain barrier (BBB) provide a significant opportunity to advance stroke therapy via central nervous system delivery of drugs that have neuroprotective properties. Examples of such transporters include organic anion–transporting polypeptides (Oatps) and organic cation transporters (Octs). In addition, multidrug resistance proteins (Mrps) are transporter targets in brain microvascular endothelial cells that can be exploited to preserve BBB integrity in the setting of stroke. Here, we review current knowledge on stroke pharmacotherapy and demonstrate how endogenous BBB transporters can be targeted for improvement of ischemic stroke treatment.
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Affiliation(s)
- Hrvoje Brzica
- Department of Pharmacology, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Wazir Abdullahi
- Department of Pharmacology, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Kathryn Ibbotson
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Patrick T Ronaldson
- Department of Pharmacology, College of Medicine, The University of Arizona, Tucson, AZ, USA
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24
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Klegerman ME, Moody MR, Hurling JR, Peng T, Huang SL, McPherson DD. Gas chromatography/mass spectrometry measurement of xenon in gas-loaded liposomes for neuroprotective applications. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2017; 31:1-8. [PMID: 27689777 PMCID: PMC5154815 DOI: 10.1002/rcm.7749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/16/2016] [Accepted: 09/25/2016] [Indexed: 06/06/2023]
Abstract
RATIONALE We have produced a liposomal formulation of xenon (Xe-ELIP) as a neuroprotectant for inhibition of brain damage in stroke patients. This mandates development of a reliable assay to measure the amount of dissolved xenon released from Xe-ELIP in water and blood samples. METHODS Gas chromatography/mass spectrometry (GC/MS) was used to quantify xenon gas released into the headspace of vials containing Xe-ELIP samples in water or blood. In order to determine blood concentration of xenon in vivo after Xe-ELIP administration, 6 mg of Xe-ELIP lipid was infused intravenously into rats. Blood samples were drawn directly from a catheterized right carotid artery. After introduction of the samples, each vial was allowed to equilibrate to 37°C in a water bath, followed by 20 minutes of sonication prior to headspace sampling. Xenon concentrations were calculated from a gas dose-response curve and normalized using the published xenon water-gas solubility coefficient. RESULTS The mean corrected percent of xenon from Xe-ELIP released into water was 3.87 ± 0.56% (SD, n = 8), corresponding to 19.3 ± 2.8 μL/mg lipid, which is consistent with previous independent Xe-ELIP measurements. The corresponding xenon content of Xe-ELIP in rat blood was 23.38 ± 7.36 μL/mg lipid (n = 8). Mean rat blood xenon concentration after intravenous administration of Xe-ELIP was 14 ± 10 μM, which is approximately 15% of the estimated neuroprotective level. CONCLUSIONS Using this approach, we have established a reproducible method for measuring dissolved xenon in fluids. These measurements have established that neuroprotective effects can be elicited by less than 20% of the calculated neuroprotective xenon blood concentration. More work will have to be done to establish the protective xenon pharmacokinetic range. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Melvin E. Klegerman
- University of Texas Health Science Center - Houston, Department of Internal Medicine, Division of Cardiovascular Medicine, 1941 East Road, Houston, Texas 77054, U.S.A
| | - Melanie R. Moody
- University of Texas Health Science Center - Houston, Department of Internal Medicine, Division of Cardiovascular Medicine, 1941 East Road, Houston, Texas 77054, U.S.A
| | - Jermaine R. Hurling
- University of Texas Health Science Center - Houston, Department of Internal Medicine, Division of Cardiovascular Medicine, 1941 East Road, Houston, Texas 77054, U.S.A
| | - Tao Peng
- University of Texas Health Science Center - Houston, Department of Internal Medicine, Division of Cardiovascular Medicine, 1941 East Road, Houston, Texas 77054, U.S.A
| | - Shao-Ling Huang
- University of Texas Health Science Center - Houston, Department of Internal Medicine, Division of Cardiovascular Medicine, 1941 East Road, Houston, Texas 77054, U.S.A
| | - David D. McPherson
- University of Texas Health Science Center - Houston, Department of Internal Medicine, Division of Cardiovascular Medicine, 1941 East Road, Houston, Texas 77054, U.S.A
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25
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Gould IG, Tsai P, Kleinfeld D, Linninger A. The capillary bed offers the largest hemodynamic resistance to the cortical blood supply. J Cereb Blood Flow Metab 2017; 37:52-68. [PMID: 27780904 PMCID: PMC5363755 DOI: 10.1177/0271678x16671146] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 06/15/2016] [Accepted: 07/30/2016] [Indexed: 01/09/2023]
Abstract
The cortical angioarchitecture is a key factor in controlling cerebral blood flow and oxygen metabolism. Difficulties in imaging the complex microanatomy of the cortex have so far restricted insight about blood flow distribution in the microcirculation. A new methodology combining advanced microscopy data with large scale hemodynamic simulations enabled us to quantify the effect of the angioarchitecture on the cerebral microcirculation. High-resolution images of the mouse primary somatosensory cortex were input into with a comprehensive computational model of cerebral perfusion and oxygen supply ranging from the pial vessels to individual brain cells. Simulations of blood flow, hematocrit and oxygen tension show that the wide variation of hemodynamic states in the tortuous, randomly organized capillary bed is responsible for relatively uniform cortical tissue perfusion and oxygenation. Computational analysis of microcirculatory blood flow and pressure drops further indicates that the capillary bed, including capillaries adjacent to feeding arterioles (d < 10 µm), are the largest contributors to hydraulic resistance.
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Affiliation(s)
- Ian Gopal Gould
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Philbert Tsai
- Department of Physics, University of California at San Diego, San Diego, CA, USA
| | - David Kleinfeld
- Department of Physics, University of California at San Diego, San Diego, CA, USA
| | - Andreas Linninger
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
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Bake S, Gardner R, Tingling JD, Miranda RC, Sohrabji F. Fetal Alcohol Exposure Alters Blood Flow and Neurological Responses to Transient Cerebral Ischemia in Adult Mice. Alcohol Clin Exp Res 2016; 41:117-127. [PMID: 27987329 DOI: 10.1111/acer.13277] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/25/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can result in physical and neurocognitive deficits that are collectively termed "fetal alcohol spectrum disorders" (FASD). Although FASD is associated with lifelong intellectual disability, the mechanisms mediating the emergence of secondary mental health and physical disabilities are poorly understood. Based on our previous data showing that maternal ethanol (EtOH) exposure in mice resulted in an immediate reduction in cranially directed fetal blood flow, we hypothesized that such exposure would also result in persistent alterations in cranially directed blood flow in the prenatally alcohol-exposed (PAE) adult. We also hypothesized that PAE adults exposed to an acute cerebrovascular insult would exhibit more brain damage and neurobehavioral impairment compared to non-PAE adult controls. METHODS Pregnant C57BL/6 mice were exposed to EtOH, 3 g/kg, or water by intragastric gavage. Blood flow in carotid, renal, and femoral arteries was assessed by ultrasound imaging in PAE and control adults at 3, 6, and 12 months of age. To mimic ischemic stroke in young adult populations, 3-month-old PAE and control animals were subject to transient middle cerebral artery occlusion (MCAo) and subsequently assessed for behavioral recovery, stroke infarct volume, and brain cytokine profiles. RESULTS PAE resulted in a significant age-related decrease in blood acceleration in adult mice, specifically in the carotid artery. A unilateral transient MCAo resulted in equivalent cortico-striatal damage in both PAE and control adults. However, PAE adult mice exhibited significantly decreased poststroke behavioral recovery compared to controls. CONCLUSIONS Our data collectively show that PAE adult mice exhibit a persistent, long-term loss of cranially directed blood flow, and decreased capacity to compensate for brain trauma due to acute-onset adult diseases like ischemic stroke.
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Affiliation(s)
- Shameena Bake
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, College of Medicine, Bryan, Texas
| | - Rachel Gardner
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, College of Medicine, Bryan, Texas
| | - Joseph D Tingling
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, College of Medicine, Bryan, Texas
| | - Rajesh C Miranda
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, College of Medicine, Bryan, Texas
| | - Farida Sohrabji
- Women's Health in Neuroscience Program, Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, College of Medicine, Bryan, Texas
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Semenov S, Huynh T, Williams T, Nicholson B, Vasilenko A. Dielectric properties of brain tissue at 1 GHz in acute ischemic stroke: Experimental study on swine. Bioelectromagnetics 2016; 38:158-163. [PMID: 27901288 DOI: 10.1002/bem.22024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 11/02/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | - Toan Huynh
- Carolinas Medical Center, Charlotte, North Carolina
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28
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Inoue A, Kohno K, Iwata S, Ohue S, Ozaki S, Ninomiya S, Tomita H, Kamogawa K, Okamoto K, Fukumoto S, Ichikawa H, Onoue S, Nakamura Y, Okuda B. Efficacy of Early Superficial Temporal Artery-Middle Cerebral Artery Double Anastomoses for Atherosclerotic Occlusion in Patients with Progressing Stroke. J Stroke Cerebrovasc Dis 2016; 26:741-748. [PMID: 27816279 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/30/2016] [Accepted: 10/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We investigated the efficacy of early superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses for patients with progressing stroke due to atherosclerotic occlusion. MATERIALS AND METHODS Nine consecutive patients who underwent early STA-MCA double anastomoses were enrolled. All patients presented with progressing stroke despite maximal medical treatment. Cerebral blood flow in 7 patients was analyzed by single-photon emission tomography. Clinical outcomes were investigated postoperatively, and we evaluated the utility of early STA-MCA double anastomoses. RESULTS Nine patients in the present study included those with middle cerebral artery occlusion (n = 6) and internal carotid artery occlusion (n = 3). The mean age was 58.4 years. Subjects comprised 1 female (11.1%) and 8 males (88.9%). The cause was low perfusion ischemia due to atherosclerotic occlusion with a small infarct. The mean regional cerebral blood flow (rCBF) ratio in the middle cerebral artery territory compared to the normal side was 69.6 ± 5.3%. The duration from onset to surgery was 1-8 days (median, 3.11 days). All patients underwent early STA-MCA double anastomoses, and no reperfusion-induced hemorrhage occurred. All of them slowly achieved obvious remission compared to symptoms on admission and achieved a good functional outcome. CONCLUSIONS Early STA-MCA double anastomoses were safe and effective, and early revascularization resulted in rapid neurological improvement. We recommend this procedure for patients with progressive ischemia due to main trunk artery occlusion, when the rCBF flow ratio with the normal side was 70 ± 10%, even at the subacute stage.
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Affiliation(s)
- Akihiro Inoue
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
| | - Kanehisa Kohno
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Shinji Iwata
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Shiro Ohue
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Saya Ozaki
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Satoko Ninomiya
- Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Hitomi Tomita
- Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Kenji Kamogawa
- Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Kensho Okamoto
- Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Shinya Fukumoto
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Haruhisa Ichikawa
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Shinji Onoue
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Yawara Nakamura
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
| | - Bungo Okuda
- Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan
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Orakcioglu B, Kentar MM, Schiebel P, Uozumi Y, Unterberg A, Sakowitz OW. Perihemorrhagic ischemia occurs in a volume-dependent manner as assessed by multimodal cerebral monitoring in a porcine model of intracerebral hemorrhage. Neurocrit Care 2016; 22:133-9. [PMID: 25052158 DOI: 10.1007/s12028-014-0027-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Changes in the perihemorrhagic zone (PHZ) of intracerebral hemorrhage (ICH) are variable. Different mechanisms contribute to secondary neuronal injury after ICH. This multimodal monitoring study investigated early changes in the PHZ of ICH. METHODS Twenty-four swine were anesthetized, ventilated, and underwent monitoring of vital parameters. Next to an intracranial pressure-probe (ICP), microdialysis (MD), thermodiffusion cerebral blood flow (td-CBF), and oxygen probes (PbrO2) were placed into the gray white matter junction for 12 h of monitoring. ICH was induced using the autologous blood injection model. Pre-defined volumes were 0 ml (sham), 1.5 ml ipsilateral (1.5 ml), 3.0 ml ipsilateral (3.0 ml), and 3.0 ml contralateral (3.0 ml contra). RESULTS ICP equally increased in all groups after ICH. In the 3.0 ml group tissue oxygenation decreased to ischemic values of 9 ± 7 mmHg early after 6 h of monitoring. This decrease was associated with a significant perfusion reduction from 36 ± 8 ml/100 g/min to 20 ± 10 ml/100 g/min. MD correlated with a threefold lactate/pyruvate ratio increase. Measurements in all other groups were unchanged. CONCLUSION Multimodal monitoring demonstrates volume-dependent changes of tissue oxygenation, blood flow, and ischemic MD markers in the PHZ independent of increased ICP suggesting early moderate ischemia. No evidence was found for the existence of a perihemorrhagic ischemia in the small hematoma groups.
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Affiliation(s)
- Berk Orakcioglu
- Department of Neurosurgery, Ruprecht-Karls-University, Heidelberg, Germany,
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30
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Shen Y, Wang Z, Li F, Sun L. Morphological characteristics of eosinophilic neuronal death after transient unilateral forebrain ischemia in Mongolian gerbils. Neuropathology 2015; 36:227-36. [PMID: 26607557 DOI: 10.1111/neup.12264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
Various types of eosinophilic neurons (ENs) are found in the post-ischemic brain. The aim of the present study was to elucidate the temporal and spatial profile of ENs, the expression of TUNEL staining and ultrastructural characteristics in the core and peripheral regions of the cortex post-ischemia. Unilateral forebrain ischemia was induced in Mongolian gerbils by transient common carotid artery occlusions, and the brains from 3 h to 2 weeks post-ischemia were prepared for morphometric, electron microscopy (EM) and TUNEL staining of the ENs. Light microscopy showed that ENs with minimally abnormal nuclei and swollen cell bodies appeared at 3 h in the ischemic core and at 12 h in the periphery. Thereafter, ENs with pyknosis and irregular atrophic cytoplasm peaked at 12 h, pyknosis with scant cytoplasm peaked at 4 days, and TUNEL-positive staining was observed in the ischemic core. In the ischemic periphery, ENs had slightly atrophic cytoplasm and sequentially developed pyknosis, karyorrhexis and karyolysis over 1 week. These cells were also positive for TUNEL. In EM, severe organelle dilation and vacuolization preceded chromatin fragmentation in the ischemic core, while chromatin fragmentation and homogenization were the vital characteristics in the ischemic periphery. There might be two region-dependent pathways for EN changes in the post-ischemic brain: pyknosis with cytoplasmic shrinkage in the core and nuclear disintegration with slightly atrophic cytoplasm in the periphery. These pathways were comparable to necrosis and proceeded from non-classical apoptosis to necrosis, respectively.
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Affiliation(s)
- Yanling Shen
- Department of Pathology and Pathophysiology, Guilin Medical University, Guilin, Guangxi, P. R. China
| | - Zongli Wang
- Department of Pathology and Pathophysiology, Guilin Medical University, Guilin, Guangxi, P. R. China
| | - Fuying Li
- Department of Neurology and Neurological Science, Graduate School of Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Liyuan Sun
- Department of Pathology and Pathophysiology, Guilin Medical University, Guilin, Guangxi, P. R. China.,Department of Neurology and Neurological Science, Graduate School of Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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31
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Geuskens RREG, Borst J, Lucas M, Boers AMM, Berkhemer OA, Roos YBWEM, van Walderveen MAA, Jenniskens SFM, van Zwam WH, Dippel DWJ, Majoie CBLM, Marquering HA. Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke. PLoS One 2015; 10:e0141571. [PMID: 26536226 PMCID: PMC4633055 DOI: 10.1371/journal.pone.0141571] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND CT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow-up. MATERIALS AND METHODS This study included 35 patients with >100 mm brain coverage CTP. CTP processing was performed using Philips software (IntelliSpace 7.0). Final infarct was automatically segmented on follow-up noncontrast CT and used as reference. CTP and follow-up noncontrast CT image data were registered. This allowed classification of ischemic lesion agreement (core on CTP: rMTT≥145%, aCBV<2.0 ml/100g and infarct on follow-up noncontrast CT) and misclassified ischemic core (core on CTP, not identified on follow-up noncontrast CT) regions. False discovery ratio (FDR), defined as misclassified ischemic core volume divided by total CTP ischemic core volume, was calculated. Absolute and relative CTP parameters (CBV, CBF, and MTT) were calculated for both misclassified CTP ischemic core and ischemic lesion agreement regions and compared using paired rank-sum tests. RESULTS Median total CTP ischemic core volume was 49.7ml (IQR:29.9ml-132ml); median misclassified ischemic core volume was 30.4ml (IQR:20.9ml-77.0ml). Median FDR between patients was 62% (IQR:49%-80%). Median relative mean transit time was 243% (IQR:198%-289%) and 342% (IQR:249%-432%) for misclassified and ischemic lesion agreement regions, respectively. Median absolute cerebral blood volume was 1.59 (IQR:1.43-1.79) ml/100g (P<0.01) and 1.38 (IQR:1.15-1.49) ml/100g (P<0.01) for misclassified ischemic core and ischemic lesion agreement, respectively. All CTP parameter values differed significantly. CONCLUSION For all patients a considerable region of the CTP ischemic core is misclassified. CTP parameters significantly differed between ischemic lesion agreement and misclassified CTP ischemic core, suggesting that CTP analysis may benefit from revisions.
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Affiliation(s)
- Ralph R. E. G. Geuskens
- Dept. of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jordi Borst
- Dept. of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marit Lucas
- Dept. of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - A. M. Merel Boers
- Dept. of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | - Wim H. van Zwam
- Dept. of Radiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | | | - Henk A. Marquering
- Dept. of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- Dept. of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Martynov MY, Gusev EI. Current knowledge on the neuroprotective and neuroregenerative properties of citicoline in acute ischemic stroke. J Exp Pharmacol 2015; 7:17-28. [PMID: 27186142 PMCID: PMC4863531 DOI: 10.2147/jep.s63544] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ischemic stroke is one of the leading causes of long-lasting disability and death. Two main strategies have been proposed for the treatment of ischemic stroke: restoration of blood flow by thrombolysis or mechanical thrombus extraction during the first few hours of ischemic stroke, which is one of the most effective treatments and leads to a better functional and clinical outcome. The other direction of treatment, which is potentially applicable to most of the patients with ischemic stroke, is neuroprotection. Initially, neuroprotection was mainly targeted at protecting gray matter, but during the past few years there has been a transition from a neuron-oriented approach toward salvaging the whole neurovascular unit using multimodal drugs. Citicoline is a multimodal drug that exhibits neuroprotective and neuroregenerative effects in a variety of experimental and clinical disorders of the central nervous system, including acute and chronic cerebral ischemia, intracerebral hemorrhage, and global cerebral hypoxia. Citicoline has a prolonged therapeutic window and is active at various temporal and biochemical stages of the ischemic cascade. In acute ischemic stroke, citicoline provides neuroprotection by attenuating glutamate exitotoxicity, oxidative stress, apoptosis, and blood–brain barrier dysfunction. In the subacute and chronic phases of ischemic stroke, citicoline exhibits neuroregenerative effects and activates neurogenesis, synaptogenesis, and angiogenesis and enhances neurotransmitter metabolism. Acute and long-term treatment with citicoline is safe and in most clinical studies is effective and improves functional outcome.
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Affiliation(s)
- Mikhail Yu Martynov
- Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, Moscow, Russia
| | - Eugeny I Gusev
- Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, Moscow, Russia
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Bibic A, Knutsson L, Schmidt A, Henningsson E, Månsson S, Abul-Kasim K, Åkeson J, Gunther M, Ståhlberg F, Wirestam R. Measurement of vascular water transport in human subjects using time-resolved pulsed arterial spin labelling. NMR IN BIOMEDICINE 2015; 28:1059-1068. [PMID: 26147641 DOI: 10.1002/nbm.3344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 04/30/2015] [Accepted: 05/20/2015] [Indexed: 06/04/2023]
Abstract
Most approaches to arterial spin labelling (ASL) data analysis aim to provide a quantitative measure of the cerebral blood flow (CBF). This study, however, focuses on the measurement of the transfer time of blood water through the capillaries to the parenchyma (referred to as the capillary transfer time, CTT) as an alternative parameter to characterise the haemodynamics of the system. The method employed is based on a non-compartmental model, and no measurements need to be added to a common time-resolved ASL experiment. Brownian motion of labelled spins in a potential was described by a one-dimensional general Langevin equation as the starting point, and as a Fokker-Planck differential equation for the averaged distribution of labelled spins at the end point, which takes into account the effects of flow and dispersion of labelled water by the pseudorandom nature of the microvasculature and the transcapillary permeability. Multi-inversion time (multi-TI) ASL data were acquired in 14 healthy subjects on two occasions in a test-retest design, using a pulsed ASL sequence and three-dimensional gradient and spin echo (3D-GRASE) readout. Based on an error analysis to predict the size of a region of interest (ROI) required to obtain reasonably precise parameter estimates, data were analysed in two relatively large ROIs, i.e. the occipital lobe (OC) and the insular cortex (IC). The average values of CTT in OC were 260 ± 60 ms in the first experiment and 270 ± 60 ms in the second experiment. The corresponding IC values were 460 ± 130 ms and 420 ± 139 ms, respectively. Information related to the water transfer time may be important for diagnostics and follow-up of cerebral conditions or diseases characterised by a disrupted blood-brain barrier or disturbed capillary blood flow.
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Affiliation(s)
- Adnan Bibic
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Anders Schmidt
- Department of Anaesthesiology and Intensive Care Medicine, Helsingborg Hospital, Helsingborg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Sven Månsson
- Department of Medical Radiation Physics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Kasim Abul-Kasim
- Department of Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jonas Åkeson
- Department of Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Freddy Ståhlberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Lund University Bioimaging Centre, Lund University, Lund, Sweden
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
| | - Ronnie Wirestam
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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NCX1 Exchanger Cooperates with Calretinin to Confer Preconditioning-Induced Tolerance Against Cerebral Ischemia in the Striatum. Mol Neurobiol 2015; 53:1365-1376. [DOI: 10.1007/s12035-015-9095-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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35
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Schoknecht K, Prager O, Vazana U, Kamintsky L, Harhausen D, Zille M, Figge L, Chassidim Y, Schellenberger E, Kovács R, Heinemann U, Friedman A. Monitoring stroke progression: in vivo imaging of cortical perfusion, blood-brain barrier permeability and cellular damage in the rat photothrombosis model. J Cereb Blood Flow Metab 2014; 34:1791-801. [PMID: 25160672 PMCID: PMC4269756 DOI: 10.1038/jcbfm.2014.147] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/15/2014] [Accepted: 07/21/2014] [Indexed: 11/09/2022]
Abstract
Focal cerebral ischemia is among the main causes of death and disability worldwide. The ischemic core often progresses, invading the peri-ischemic brain; however, assessing the propensity of the peri-ischemic brain to undergo secondary damage, understanding the underlying mechanisms, and adjusting treatment accordingly remain clinically unmet challenges. A significant hallmark of the peri-ischemic brain is dysfunction of the blood-brain barrier (BBB), yet the role of disturbed vascular permeability in stroke progression is unclear. Here we describe a longitudinal in vivo fluorescence imaging approach for the evaluation of cortical perfusion, BBB dysfunction, free radical formation and cellular injury using the photothrombosis vascular occlusion model in male Sprague Dawley rats. Blood-brain barrier dysfunction propagated within the peri-ischemic brain in the first hours after photothrombosis and was associated with free radical formation and cellular injury. Inhibiting free radical signaling significantly reduced progressive cellular damage after photothrombosis, with no significant effect on blood flow and BBB permeability. Our approach allows a dynamic follow-up of cellular events and their response to therapeutics in the acutely injured cerebral cortex.
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Affiliation(s)
- Karl Schoknecht
- Institute for Neurophysiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Ofer Prager
- Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Udi Vazana
- Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lyn Kamintsky
- Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Denise Harhausen
- Department of Experimental Neurology, Center for Stroke Research Berlin (CSB), Charité-University Medicine Berlin, Berlin, Germany
| | - Marietta Zille
- Department of Experimental Neurology, Center for Stroke Research Berlin (CSB), Charité-University Medicine Berlin, Berlin, Germany
| | - Lena Figge
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Yoash Chassidim
- Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyk Schellenberger
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Richard Kovács
- Institute for Neurophysiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Uwe Heinemann
- Institute for Neurophysiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Alon Friedman
- 1] Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, The Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel [2] Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Marsh EB, Leigh R, Radvany M, Gailloud P, Llinas RH. Collaterals: an important determinant of prolonged ischemic penumbra versus rapid cerebral infarction? Front Neurol 2014; 5:208. [PMID: 25352827 PMCID: PMC4196524 DOI: 10.3389/fneur.2014.00208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/30/2014] [Indexed: 01/19/2023] Open
Abstract
Intravenous tissue plasminogen activator is the mainstay for the treatment of acute ischemic stroke in patients presenting within 4.5 h of symptom onset. Studies have demonstrated that treating patients early leads to improved long-term outcomes. MR imaging currently allows quantification of the ischemic penumbra in order to better identify individuals most likely to benefit from intervention, irrespective of “time last seen normal.” Its increasing use in clinical practice has demonstrated individual differences in rate of infarction. One explanation for this variability is a difference in collateral blood flow. We report two cases that highlight the individual variability of infarction rate, and discuss potential underlying mechanisms that may influence treatment decisions and outcomes.
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Affiliation(s)
- Elisabeth Breese Marsh
- Department of Neurology, The Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Department of Neurology, Johns Hopkins Bayview Medical Center , Baltimore, MD , USA
| | - Richard Leigh
- Department of Neurology, The Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Martin Radvany
- Department of Radiology, The Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Philippe Gailloud
- Department of Radiology, The Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Rafael H Llinas
- Department of Neurology, The Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Department of Neurology, Johns Hopkins Bayview Medical Center , Baltimore, MD , USA
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Rostami E, Engquist H, Johnson U, Howells T, Ronne-Engström E, Nilsson P, Hillered L, Lewén A, Enblad P. Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients with Subarachnoid Hemorrhage - A Xenon-CT and Microdialysis Study. Front Neurol 2014; 5:89. [PMID: 24917850 PMCID: PMC4041006 DOI: 10.3389/fneur.2014.00089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/20/2014] [Indexed: 01/10/2023] Open
Abstract
Cerebral ischemia is the leading cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Although 70% of the patients show angiographic vasospasm only 30% develop symptomatic vasospasm defined as delayed cerebral ischemia (DCI). Early detection and management of reversible ischemia is of critical importance in patients with SAH. Using a bedside Xenon enhanced computerized tomography (Xenon-CT) scanner makes it possible to measure quantitative regional Cerebral blood flow (CBF) bedside in the neurointensive care setting and intracerebral microdialysis (MD) is a method that offers the possibility to monitor the metabolic state of the brain continuously. Here, we present results from nine SAH patients with both MD monitoring and bedside Xenon-CT measurements. CBF measurements were performed within the first 72 h following bleeding. Six out of nine patients developed DCI at a later stage. Five out of six patients who developed DCI had initial global CBF below 26 ml/100 g/min whereas one had 53 ml/100 g/min. The three patients who did not develop clinical vasospasm all had initial global CBF above 27 ml/100 g/min. High lactate/pyruvate (L/P) ratio was associated with lower CBF values in the area surrounding the catheter. Five out of nine patients had L/P ratio ≥25 and four of these patients had CBF ≤ 22 ml/100 g/min. These preliminary results suggest that patients with initially low global CBF on Xenon-CT may be more likely to develop DCI. Initially low global CBF was accompanied with metabolic disturbances determined by the MD. Most importantly, pathological findings on the Xenon-CT and MD could be observed before any clinical signs of DCI. Combining bedside Xenon-CT and MD was found to be useful and feasible. Further studies are needed to evaluate if DCI can be detected before any other signs of DCI to prevent progress to infarction.
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Affiliation(s)
- Elham Rostami
- Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Henrik Engquist
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University , Uppsala , Sweden
| | - Ulf Johnson
- Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Timothy Howells
- Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | | | - Pelle Nilsson
- Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Lars Hillered
- Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Anders Lewén
- Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Per Enblad
- Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
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Dolan R, Linden D, Johnston T, Paterson G, Rossi J, Lynch N, Arbuckle S, MacLean A, Davey P. Learning safe practice by improving care: student-led intervention on oxygen prescribing in a respiratory ward. Scott Med J 2013; 58:204-8. [PMID: 24215037 DOI: 10.1177/0036933013508062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The primary aim of this intervention was to improve oxygen prescribing in accordance with the 2008 British Thoracic Society guidelines for the prescription of emergency oxygen in adults. METHODS Eight final year medical students reviewed the drug charts of all patients admitted to the respiratory ward on a daily basis in order to collect data on five audit questions: (1) Has oxygen (O2) been prescribed? (2) Has an O2 target saturation level been indicated? (3) Has O2 been prescribed as an 'as required' (PRN) or 'continuous therapy'? (4) Has the prescription been signed? (5) Has O2 been signed for in every drug round since the original prescription? Following an initial audit cycle an educational poster was distributed to all clinical staff via email and hard copies of the poster were placed strategically throughout the ward before its effectiveness was measured. RESULTS During the pre-intervention phase, compliance with all five measures varied from 0 to 25%. There was an increase in the variation in compliance after the poster intervention to 14-44%; however, this masked better overall compliance with all five investigative questions with figures of 44%, 39% and 42% being recorded in three of the four post-intervention days. Overall there was increased compliance with four of the five audit questions. Indeed compliance with question 3 rose from 14% to 83%. CONCLUSIONS The poster intervention was marginally effective while also showing that students can improve prescribing in a clinical setting.
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Affiliation(s)
- R Dolan
- Specialty Registrar, University of Dundee Medical School, UK
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Guo ZN, Yang G, Zhou HW, Wang J, Wu J, Yang Y. Xenon-enhanced CT assessment of cerebral blood flow in stroke-in-progress patients with unilateral internal carotid artery or middle cerebral artery stenosis. Neurosci Bull 2013; 29:693-700. [PMID: 24019158 DOI: 10.1007/s12264-013-1376-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/24/2013] [Indexed: 11/26/2022] Open
Abstract
Carotid or cerebral artery stenosis resulting in low perfusion is a major cause of ischemic stroke. Understanding the unique hemodynamic features in each patient undergoing a stroke-in-progress (SIP) and the correlation between progression and cerebral blood flow (CBF) status would help in the diagnosis and treatment of individual patients. We used xenon-enhanced CT (Xe-CT) to examine cerebral perfusion in patients with or without SIP (30 patients/group), recruited from October 2009 to October 2010. Only SIP patients with unilateral stenosis in the internal or middle cerebral artery were recruited. The occurrence of watershed infarction was higher in the SIP group than in the non-SIP group (P <0.05). In the SIP group, larger hypoperfused areas were found around the lesions than in the non-SIP group. In the SIP group, the CBF values in the ipsilateral areas were significantly lower than those in corresponding regions on the contralateral side. CBF values in the contralateral hemisphere were significantly lower in the SIP group than in the non-SIP group. In SIP patients, infarctions were surrounded by larger hypoperfused areas than in non-SIP patients. These larger hypoperfused areas may result in pathological damage to the brain that is responsible for the progression of stroke.
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Affiliation(s)
- Zhen-Ni Guo
- Department of Neurology, the First Norman Bethune Hospital of Jilin University, Changchun, 130021, China
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Does modern ischemic stroke therapy in a large community-based dedicated stroke center improve clinical outcomes? A two-year retrospective study. J Stroke Cerebrovasc Dis 2013; 23:869-78. [PMID: 24011839 DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 06/10/2013] [Accepted: 07/08/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To compare modern endovascular therapies in the acute ischemic stroke patients leading to more comprehensive acute stroke algorithm. METHODS A 2-year retrospective nonrandomized study on 76 patients who were placed into 5 different treatment groups for acute ischemic stroke. These groups included: group 1 (no treatment) (n = 24), group 2 (intravenous tissue plasminogen activator [tPA] only) (n = 18), group 3 (intra-arterial [IA] tPA) (n = 9), group 4 (Mechanical Embolus Removal in Cerebral Ischemia [MERCI]; retrieval only) (n = 17), and group 5 (combined IA/MERCI) (n = 8). Age range for all groups was 29-92 years. There were 39 women (51.3%) and 37 men (48.7%). The mean age for all patients was 70.1 years. The pre- and post-National Institutes of Health Stroke Scale (NIHSS) values were obtained for each group on arrival and discharge from the hospital. The results of the 4 treatment cohorts were compared with the no treatment group, providing the relative efficacy of these procedures compared with conservative medical therapy alone. RESULTS Group 1 presented with an admission NIHSS value of 11.1 and 8.9 on discharge from the hospital. There was a NIHSS reduction of 2.2 without treatment. Group 2 had an admission NIHSS value of 11.8 and a discharge value of 4.7, resulting in an NIHSS reduction of 7.1. Group 3 had an admission NIHSS value of 16.1 and 7.4 at discharge, resulting in an NIHSS reduction of 8.7. Group 4 had an admission NIHSS value of 15.9 and discharge NIHSS value of 3.1, with an NIHSS reduction of 12.8. Group 5 had an admission NIHSS score of 15.7 and 10.6 at discharge, with an NIHSS reduction of 5.1. Four patients expired during their admission, 2 from group 1 (control group) and 2 from group 5 (combined IA/MERCI group). There was a statistically significant difference for the 5 groups at the P < .05 level in change in NIHSS scores: F (4, 24) = 9.10, P = .000. CONCLUSIONS Modern endovascular therapies for acute ischemic stroke do improve clinical outcomes when implemented in the setting of a dedicated comprehensive stroke team.
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Peng T, Britton GL, Kim H, Cattano D, Aronowski J, Grotta J, McPherson DD, Huang SL. Therapeutic time window and dose dependence of xenon delivered via echogenic liposomes for neuroprotection in stroke. CNS Neurosci Ther 2013; 19:773-84. [PMID: 23981565 DOI: 10.1111/cns.12159] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 06/23/2013] [Accepted: 06/24/2013] [Indexed: 12/14/2022] Open
Abstract
AIMS Neurologic impairment following ischemic injury complicates the quality of life for stroke survivors. Xenon (Xe) has favorable neuroprotective properties to modify stroke. Xe delivery is hampered by a lack of suitable administration strategies. We have developed Xe-containing echogenic liposomes (Xe-ELIP) for systemic Xe delivery. We investigated the time window for Xe-ELIP therapeutic effect and the most efficacious dose for neuroprotection. Molecular mechanisms for Xe neuroprotection were investigated. METHODS Xenon-containing echogenic liposomes were created by a previously developed pressurization-freezing method. Following right middle cerebral artery occlusion (2 h), animals were treated with Xe-ELIP at 2, 3, or 5 h to determine time window of therapeutic effect. The neuroprotectant dosage for optimal effect was evaluated 3 h after stroke onset. Expression of brain-derived neurotrophic factor (BDNF), protein kinase B (Akt), and mitogen-activated protein kinases (MAPK) was determined. RESULTS Xenon-containing echogenic liposomes administration for up to 5 h after stroke onset reduced infract size. Treatment groups given 7 and 14 mg/kg of Xe-ELIP reduced infarct size. Behavioral outcomes corresponded to changes in infarct volume. Xe-ELIP treatment reduced ischemic neuronal cell death via activation of both MAPK and Akt. Elevated BDNF expression was shown following Xe-ELIP delivery. CONCLUSION This study demonstrates the therapeutic efficacy of Xe-ELIP administered within 5 h after stroke onset with an optimal dosage range of 7-14 mg/kg for maximal neuroprotection.
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Affiliation(s)
- Tao Peng
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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Frostig RD, Lay CC, Davis MF. A rat's whiskers point the way toward a novel stimulus-dependent, protective stroke therapy. Neuroscientist 2013; 19:313-28. [PMID: 23047156 PMCID: PMC3710106 DOI: 10.1177/1073858412462607] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is the fourth leading cause of death in the United States and the leading cause of long-term disability. Ischemic stroke, due to an interruption in blood supply, is particularly prevalent; 87% of all strokes are ischemic. Unfortunately, current options for acute treatment are extremely limited and there is a great need for new treatment strategies. This review will discuss evidence that mild sensory stimulation can completely protect the jeopardized brain from an impending stroke in a rodent model. When delivered within the first 2 hours following ischemic onset, this stimulation results in complete protection, including a full reestablishment of cortical function, sensorimotor capabilities, and blood flow. Identical stimulation, however, initiated 3 hours following ischemic onset, results in an increase in damage compared with untreated animals. The protective effect is not specific to a single sensory modality, anesthesia, or age, and increasing evoked cortical activity by increasing stimulation accelerates recovery. Taken together, these findings demonstrate that cortical activity is a critical factor for protection and suggest a new, exciting potential avenue for the development of acute stroke treatment strategies that may produce a noninvasive, drug-free, equipment-free, and side effect-free means of protecting from ischemic stroke.
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Affiliation(s)
- Ron D Frostig
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA 92697, USA.
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Liu X. Beyond the time window of intravenous thrombolysis: standing by or by stenting? INTERVENTIONAL NEUROLOGY 2012; 1:3-15. [PMID: 25187761 PMCID: PMC4031767 DOI: 10.1159/000338389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intravenous administration of tissue plasminogen activator within 4.5 h of symptom onset is presently the 'golden rule' for treating acute ischemic stroke. However, many patients miss the time window and others reject this treatment due to a long list of contraindications. Mechanical embolectomy has recently progressed as a potential alternative for treating patients beyond the time window for IV thrombolysis. In this paper, recent progress in mechanical embolectomy, angioplasty, and stenting in acute stroke is reviewed. Despite worries concerning the long-term clinical outcomes and increased risk of intracranial hemorrhage, favorable clinical outcomes may be achieved after mechanical embolectomy in carefully selected patients even 4.5 h after stroke onset. Potential steps should be prepared and attempted in these patients whose opportunity for recovery will elapse in a flash.
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Affiliation(s)
- Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Fox AJ, Symons SP, Howard P, Yeung R, Aviv RI. Acute stroke imaging: CT with CT angiography and CT perfusion before management decisions. AJNR Am J Neuroradiol 2012; 33:792-4. [PMID: 22442040 DOI: 10.3174/ajnr.a3099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gaur V, Kumar A. Effect of nonselective and selective COX-2 inhibitors on memory dysfunction, glutathione system, and tumor necrosis factor alpha level against cerebral ischemia reperfusion injury. Drug Chem Toxicol 2011; 35:218-24. [DOI: 10.3109/01480545.2011.589850] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Moreira MS, Velasco IT, Ferreira LS, Ariga SKK, Abatepaulo F, Grinberg LT, Marques MM. Effect of laser phototherapy on wound healing following cerebral ischemia by cryogenic injury. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2011; 105:207-15. [PMID: 22024356 DOI: 10.1016/j.jphotobiol.2011.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 08/09/2011] [Accepted: 09/28/2011] [Indexed: 11/29/2022]
Abstract
Laser phototherapy emerges as an alternative or auxiliary therapy for acute ischemic stroke, traumatic brain injury, degenerative brain disease, spinal cord injury, and peripheral nerve regeneration, but its effects are still controversial. We have previously found that laser phototherapy immunomodulates the response to focal brain damage. Following direct cortical cryogenic injury the effects of laser phototherapy on inflammation and repair was assessed after cryogenic injury (CI) to the central nervous system (CNS) of rats. The laser phototherapy was carried out with a 780 nm AlGaAs diode laser. The irradiation parameters were: power of 40 mW, beam area of 0.04 cm(2), energy density of 3 J/cm(2) (3s) in two points (0.12 J per point). Two irradiations were performed at 3 h-intervals, in contact mode. Rats (20 non-irradiated - controls and 20 irradiated) were used. The wound healing in the CNS was followed in 6 h, 1, 7 and 14 days after the last irradiation. The size of the lesions, the neuron cell viability percentages and the amount of positive GFAP labeling were statistically compared by ANOVA complemented by Tukey's test (p<0.05). The distribution of lymphocytes, leukocytes and macrophages were also analyzed. CI created focal lesions in the cortex represented by necrosis, edema, hemorrhage and inflammatory infiltrate. The most striking findings were: lased lesions showed smaller tissue loss than control lesions in 6 h. During the first 24 h the amount of viable neurons was significantly higher in the lased group. There was a remarkable increase in the amount of GFAP in the control group by 14 days. Moreover, the lesions of irradiated animals had fewer leukocytes and lymphocytes in the first 24 h than controls. Considering the experimental conditions of this study it was concluded that laser phototherapy exerts its effect in wound healing following CI by controlling the brain damage, preventing neuron death and severe astrogliosis that could indicate the possibility of a better clinical outcome.
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Affiliation(s)
- Maria S Moreira
- School of Dentistry, Universidade de São Paulo, São Paulo 05508-000, Brazil
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Wang Y, Yang YS, Tang XC, Zhang HY. T33, a novel peroxisome proliferator-activated receptor γ/α agonist, exerts neuroprotective action via its anti-inflammatory activities. Acta Pharmacol Sin 2011; 32:1100-8. [PMID: 21804572 DOI: 10.1038/aps.2011.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To examine the neuroprotective effects of T33, a peroxisome proliferator-activated receptor gamma/alpha (PPARγ/α) agonist, in acute ischemic models in vitro and in vivo. METHODS Primary astrocytes subjected to oxygen-glucose deprivation/reperfusion (O/R) and BV-2 cells subjected to hypoxia were used as a model simulating the ischemic core and penumbra, respectively. The mRNA levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were measured using qPCR. The levels of TNF-α secreted by BV-2 cells were measured using ELISA. Protein levels of cyclooxygenase-2 (COX-2), p65, phosphorylated I-κBα/I-κBα, phosphorylated I-κB kinase (pIKK), phosphorylated eukaryote initiation factor 2α (p-eIF-2α)/eIF-2α and p-p38/p38 were detected using Western blot. PPARγ activity was measured using EMSA. The neuroprotection in vivo was examined in rat middle cerebral artery occlusion (MCAO) model with neurological scoring and TTC staining. RESULTS Addition of T33 (0.5 μmol/L) increased the level of I-κBα protein in primary astrocytes subjected to O/R, which was due to promoting protein synthesis without affecting degradation. In primary astrocytes subjected to O/R, addition of T33 amplified I-κBα gene transcription and mRNA translation, thus suppressing the nuclear factor-kappa B (NF-κB) pathway and reducing inflammatory mediators (TNF-α, IL-1β, and COX-2). In BV-2 cells subjected to hypoxia, T33 (0.5 μmol/L) reduced TNF-α, COX-2, and p-P38 production, which was antagonized by pre-administration of the specific PPARγ antagonist GW9662 (30 μmol/L). T33 (2 mg/kg, ip) attenuated MCAO-induced inflammatory responses and brain infarction, which was antagonized by pre-administered GW9662 (4 mg/kg, ip). CONCLUSION T33 exerted anti-inflammatory effects in the ischemic core and penumbra via PPARγ activation, which contributed to its neuroprotective action.
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Srour JM, Shin W, Shah S, Sen A, Carroll TJ. SCALE-PWI: A pulse sequence for absolute quantitative cerebral perfusion imaging. J Cereb Blood Flow Metab 2011; 31:1272-82. [PMID: 21157469 PMCID: PMC3099632 DOI: 10.1038/jcbfm.2010.215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Bookend technique is a magnetic resonance imaging (MRI) dynamic susceptibility contrast method that provides reliable quantitative measurement of cerebral blood flow (CBF) and cerebral blood volume (CBV). The quantification is patient specific, is derived from a steady-state measurement of CBV, and is obtained from T(1) changes in the white matter and the blood pool after contrast agent injection. In the current implementation, the Bookend technique consists of three scanning steps requiring a cumulative scan time of 3 minutes 47 seconds, a well-trained technologist, and extra time for offline image reconstruction. We present an automation and acceleration of the multiscan Bookend protocol through a self-calibrating pulse sequence, namely Self-Calibrated Epi Perfusion-Weighted Imaging (SCALE-PWI). The SCALE-PWI is a single-shot echo-planar imaging pulse sequence with three modules and a total scan time of under 2 minutes. It provides the possibility of performing online, quantitative perfusion image reconstruction, which reduces the latency to obtain quantitative maps. A validation study in healthy volunteers (N=19) showed excellent agreement between SCALE-PWI and the conventional Bookend protocol (P>0.05 with Student's t-test, r=0.95/slope=0.98 for quantitative CBF, and r=0.91/slope=0.94 for quantitative CBV). A single MRI pulse sequence for absolute quantification of cerebral perfusion has been developed.
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Affiliation(s)
- Jessy Mouannes Srour
- Department of Biomedical Engineering, Northwestern University, 737 North Michigan Avenue, Chicago, IL 60611, USA
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Shah MK, Shin W, Parikh VS, Ragin A, Mouannes J, Bernstein RA, Walker MT, Bhatt H, Carroll TJ. Quantitative cerebral MR perfusion imaging: preliminary results in stroke. J Magn Reson Imaging 2011; 32:796-802. [PMID: 20882609 DOI: 10.1002/jmri.22302] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate quantitative cerebral blood flow (qCBF) with traditional time-based measurements or metrics of cerebral perfusion: time to peak (Tmax) and mean transit time (MTT) in stroke patients. MATERIALS AND METHODS Nine ischemic stroke patients (four male, five female, 63 ± 16 years old) were included in the study which was Health Insurance Portability and Accountability Act compliant and institutional review board approved. Cerebral perfusion was quantified using the Bookend method. Mean values of qCBF, Tmax, and MTT were determined in regions of interest (ROIs). ROIs were drawn on diffusion weighted images in diffusion positive, critically ischemic (CI), in ipsilateral normal region immediately surrounding the critically ischemic region, the presumed penumbra (PP), and in contralateral diffusion negative control, presumed normal region (PN) of gray and white matter separately (GM and WM). RESULTS In both GM and WM, qCBF measures distinguished the studied brain regions with the most markedly reduced values in regions corresponding to extent of likely ischemic injury. In planned comparisons, only qCBF measurements differed significantly between CI and PP tissues. ROC analysis supported the utility of qCBF for discriminating brain regions differing in the likely extent of ischemic injury (CI and PN regions - qCBF: area under the curve [AUC] = 0.96, Tmax: AUC = 0.96, MTT: AUC = 0.72). Importantly, qCBF afforded the best discrimination of CI and PP regions (qCBF: AUC = 0.82, Tmax: AUC = 0.65, MTT: AUC = 0.52). CONCLUSION This initial evaluation indicates that quantitative MRI perfusion is feasible in ischemic stroke patients. qCBF derived with this strategy provide enhanced discrimination of CI and PP compared to time-based imaging metrics. This approach merits investigation in larger clinical studies.
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Affiliation(s)
- Maulin K Shah
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60611, USA
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Dayon L, Turck N, Garcí-Berrocoso T, Walter N, Burkhard PR, Vilalta A, Sahuquillo J, Montaner J, Sanchez JC. Brain extracellular fluid protein changes in acute stroke patients. J Proteome Res 2011; 10:1043-51. [PMID: 21142207 DOI: 10.1021/pr101123t] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In vivo human brain extracellular fluids (ECF) of acute stroke patients were investigated to assess the changes in protein levels associated with ischemic damages. Microdialysates (MDs) from the infarct core (IC), the penumbra (P), and the unaffected contralateral (CT) brain regions of patients suffering an ischemic stroke (n = 6) were compared using a shotgun proteomic approach based on isobaric tagging and mass spectrometry. Quantitative analysis showed 53 proteins with increased amounts in the IC or P with respect to the CT samples. Glutathione S-transferase P (GSTP1), peroxiredoxin-1 (PRDX1), and protein S100-B (S100B) were further assessed with ELISA on the blood of unrelated control (n = 14) and stroke (n = 14) patients. Significant increases of 8- (p = 0.0002), 20- (p = 0.0001), and 11-fold (p = 0.0093) were found, respectively. This study highlights the value of ECF as an efficient source to further discover blood stroke markers.
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Affiliation(s)
- Loï Dayon
- Biomedical Proteomics Group, Department of Structural Biology and Bioinformatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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