Ischemic Penumbra Case

stroke is an acute episode of focal dysfunction of the brain, retina, or spinal cord lasting longer than 24 h, or of any duration if imaging (CT or MRI) or autopsy show focal infarction or haemorrhage relevant to the symptoms ,which is a leading cause of death and long term disability worldwide. It results from transient or permanent disruption of cerebral blood flow, leading to necrotic death of the brain tissue supplied by the affected artery. It activates an inflammatory condition in the affected area, marked by infiltration of inflammatory cells. Inflammation can induce an apoptotic cell death in the transition region between necrotic and normal tissue, so called penumbra, for a fairly prolonged period of time.[1].

Ischaemic stroke is a serious neurological condition in which a blood clot stops blood flow to the brain and for which immediate action is required. It is the fourth cause of death in Western society, causing 87% of all strokes, and also results in long-term disability among survivors (Bunevicius et al., 2013). In the United States, about 800,000 strokes occur each year, and approximately six million Americans are living with neurological deficits caused by ischaemic strokes (Duong, 2012). Therefore, neuroradiological imaging has become a major section in radiology departments.

Mrs. September is a 55 year old woman who suffered a stroke 2 years ago. She received management for her swallowing difficulties after the stroke, and was discharged from the hospital on an oral diet with normal intake. She is currently complaining about fluctuating swallowing problems. She has also recently suffered multiple Transient Ischemic Attacks (TMIs) and has chronic multiple infarcts. She reported that she has suffered a few chest infections recently but there was no diagnosis of aspiration pneumonia. Information was gathered through a case history, followed by a Clinical Swallow Examination and from these results, a trial therapy was preformed. All this information was compiled to form a management plan for Mrs. September.

The patient is a 77-year-old obese Caucasian male with a history of abdominal hernia, stage 1 carcinoma of the bladder, and cataract, of which all have been resolved with previous surgeries. The patient also has a history of chronic atrial fibrillation (AFib) and dyslipidemia. The patient was admitted to the Emergency Room on 2/17/15 with a diagnosis of unspecified transient cerebral ischemic attack. The patient stated that he became confused while preparing dinner. He started asking his family repetitive questions. Shortly after,

An ischaemic stroke occurs due to the restriction of blood supply to an area of the brain, thus initiating a process called the ischaemic cascade (Deb, Sharma & Hassan, 2010). This begins with the depletion of local oxygen stores, causing disruptions in the production of energy compounds such as adenosine triphosphate (ATP). The depletion in energy may cause tissue death (infarction), where occlusion for 5-10 minutes may lead to irreversible brain dysfunction (Karaszewski et al., 2009). Inadequate energy supplies leads to a malfunction of cells ability to perform action potentials, also resulting in the swelling of neuron and glial cells (). Cells at the core of the ischaemia will die of necrosis (premature cell death), where apoptosis (programmed

The reason why we choose stroke is because stroke can happen anytime in our lifetime. There are two sorts of stroke. Ischemic stroke is like a heart assault, with the exception of it happens in the veins of the cerebrum. Clusters can shape in the mind's veins, in veins prompting the cerebrum, or even in veins somewhere else in the body and after that go to the cerebrum. These coagulations piece bloodstream to the mind's cells. Ischemic stroke can likewise happen when an excessive amount of plaque (greasy stores and cholesterol) obstructs the mind's veins. Around 80% of all strokes are ischemic.Hemorrhagic strokes happen when a vein in the mind breaks or bursts. The outcome is blood saturating the mind tissue, making harm cerebrum cells. The

Ischemic stroke is a prevalent and harmful disease that often results in permanent neurologic deficit. Currently, there is a dearth of therapeutic options available to improve patients’ functional recovery after stroke. A number of factors impede healing in the central nervous system, including glial scarring, a relative lack of stem cells, and growth-inhibitory proteins located in the extracellular matrix and on cell surfaces. Myelin-associated inhibitors of neurite outgrowth, found on oligodendrocytes, represent a significant obstacle to the process of cortical reorganization that occurs during recovery from infarction. Recent research has identified the mechanisms by which these inhibitors act in the setting of stroke, paving the

Mariam background is 60 year old lady admitted with left sided weakness and facial droop. Once confirmed stroke using the Recognition of Stroke in the Emergency Room (ROSIER) scale. Catangui (2015) states ROSIER scale is used to distinguish whether the patient is having a stroke or stroke mimics e.g. seizures or brain tumours. Computed tomography CT brain showed ischemic stroke. Ischaemic stroke is lack of sufficient blood supply to perfuse the brain/ cerebral tissue due to narrowing or blocked arteries in the brain (Morrison, 2014). According to Stroke Association (2015) statics shows that 1520000 strokes occur in the United Kingdom.

. Overview of processes involved ischemic stroke and high potential therapeutic microRNAs. Cerebral ischemia includes several injurious mechanisms (excitotoxicity, oxidative stress, inflammation and apoptosis) to confer neuronal injury. Potential therapeutic areas to compensate these pathogenic process include promoting angiogenesis, neurogenesis and neuroprotection which they are as recovery and repair

Capillaries, which are numerous fine vessels with thin walls that provide a large surface area where the exchange of substances occurs which connects the arteries and the veins.

The pathological changes of the carotid artery can affect the brain and on another hand the hemodynamic changes at the heart, aorta and brain can be detected at carotid artery. For example, if the narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of atherosclerotic plaque breaks off and obstructs blood flow to the brain, a stroke may develop. Therefore, this is a strong rationale to consider that cardiovascular event may ultimately be more closely related to carotid artery rather than brachial artery [5]. Carotid arteries, the major vessels supplying the brain are directly connected to aorta closer than peripheral arteries such as brachial and radial artery (Figure 1). Currently research is more focused on non-invasive determination of pressure waveform measured at carotid artery [12].

Body functions affected with an ischemic stroke are dependent on the brain artery of the vascular deprivation and the area injured in the brain. The amount of blood flow and length of time determine how much damage occurs. By understanding neural and vascular pathways as well as reactive healing can help healthcare workers be prepared for expectations, limitations, and treatments for damage caused by ischemic

This yields time-density curves for each voxel from which cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to peak (TTP) can be extrapolated. (2)

A fifteen minute window during a stroke can determine the degree of debilitation for the client, so making care available faster is a key component. An estimated 800,000 Americans suffer from a stroke each year, that’s one every 40 seconds. A stroke patient receives the only FDA-approved treatment for an ischemic stroke, which is the most prevalent kind, but first to even receive that medication, the stroke must be confirmed by a CT scan. The medication is a clot-buster called tissue plasminogen activator or tPA, and it must be administered within 2 hours of the signs of stroke to be most effective, but that doesn’t always happen in that window due to the time it takes to get care. On average, patients received a CT scan more than 20 minutes faster when using the mobile stroke unit rather than in the radiology unit of a hospital. They also noted a "significant reduction" in treatment time, 64 minutes when the mobile unit responded versus 104 minutes in the emergency room. With a CT machine in the ambulance that test can be rendered, so by the time they arrive at the hospital, the correct patient care can already be

This paper will discuss the effects perfusion has on the body as well as the multiple body systems that are effected from poor perfusion. We will be looking at the relationships between profusion as it relates to ischemic stroke, myocardial infarction, and tuberculosis. This paper will use online journal entries from EPSCO as well as off line entries from Lewis to help us find a better understanding into the related topics at hand. Lastly I will discuss stroke in depth as it pertains to my clinical experience and explain the strong link profusion has on ischemic stroke and the measures used to retain brain tissue. We will look at research done by Agarwal, Smriti (2015) that looks at the effectiveness and time saving procedures researched by his team when detecting stroke as well as research done by Dong, Hongli (2015) that shows a strong correlation between vitamin b12 and folic acid and the prevention of an ischemic event.