Microemboli in Cerebral Circulation and Alteration of Cognitive Abilities in Patients With Mechanical Prosthetic Heart Valves

Lagos, Roberto; Cabezas, F. Murillo

doi:10.1161/01.str.30.5.1150

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…To determine whether treatment will be beneficial, there is a need for advanced diagnostics that can identify the presence of an area of salvageable tissue at risk of infarction. Such an area is often described using the concept of an ischemic penumbra, first suggested for electrically dysfunctional tissue by Astrup et al [4], and further developed in terms of imaging-based penumbras by several others [5–7]. The penumbra is defined as a tissue region that is functionally impaired and at risk of infarction.…”

Section: Introductionmentioning

confidence: 99%

Defining an Acidosis-Based Ischemic Penumbra from pH-Weighted MRI

Zhou

Zijl

2011

Transl. Stroke Res.

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It has been proposed that the spatial mismatch between deficits on perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) in MRI can be used to decide regarding thrombolytic treatment in acute stroke. However, uncertainty remains about the meaning and reversibility of the perfusion deficit and even part of the diffusion deficit. Thus, there remains a need for continued development of imaging technology that can better define a potentially salvageable ischemic area at risk of infarction. Amide proton transfer (APT) imaging is a novel MRI method that can map tissue pH changes, thus providing the potential to separate the PWI/DWI mismatch into an acidosis-based penumbra and a zone of benign oligemia. In this totally noninvasive method, the pH dependence of the chemical exchange between amide protons in endogenous proteins and peptides and water protons is exploited. Early results in animal models of ischemia show promise to derive an acidosis penumbra. Possible translation to the clinic and hurdles standing in the way of achieving this are discussed.

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Section: Introductionmentioning

confidence: 99%

Defining an Acidosis-Based Ischemic Penumbra from pH-Weighted MRI

Zhou

Zijl

2011

Transl. Stroke Res.

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“… 9 Experimental and clinical studies indicate that the ischemic threshold for progression to infarction is 5–8 mL 100 g −1 min −1 within the first hours after stroke onset, but rises progressively to reach ~12–25 mL 100 g −1 min −1 if CBF is not restored and metabolic needs increase. 10 , 11 …”

Section: Current Concepts In Pathophysiology Of Cerbral Ischemiamentioning

confidence: 99%

Current knowledge on the neuroprotective and neuroregenerative properties of citicoline in acute ischemic stroke

Martynov¹,

Gusev²

2015

JEP

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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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“…Its extent however, decreases over time due to gradual deterioration and as such, represents a key target for therapeutic intervention [19]. Whereas this course of events varies from patient to patient, it has been shown that ischemic penumbra may last for many hours after stroke onset [20]. Timely rescue of the penumbra, either by restoration of blood supply or interruption of the adverse metabolic or neurochemical cascades, is the basis of acute stroke therapy.…”

Section: Ischemic Stroke Tissue Damagementioning

confidence: 99%

Magnetic Resonance Characterization of Ischemic Tissue Metabolism

Cheung

Wang²,

Sun

2011

Open Neuroimag J

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Magnetic resonance imaging (MRI) and spectroscopy (MRS) are versatile diagnostic techniques capable of characterizing the complex stroke pathophysiology, and hold great promise for guiding stroke treatment. Particularly, tissue viability and salvageability are closely associated with its metabolic status. Upon ischemia, ischemic tissue metabolism is disrupted including altered metabolism of glucose and oxygen, elevated lactate production/accumulation, tissue acidification and eventually, adenosine triphosphate (ATP) depletion and energy failure. Whereas metabolism impairment during ischemic stroke is complex, it may be monitored non-invasively with magnetic resonance (MR)-based techniques. Our current article provides a concise overview of stroke pathology, conventional and emerging imaging and spectroscopy techniques, and data analysis tools for characterizing ischemic tissue damage.

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Microemboli in Cerebral Circulation and Alteration of Cognitive Abilities in Patients With Mechanical Prosthetic Heart Valves

Cited by 8 publications

References 4 publications

Defining an Acidosis-Based Ischemic Penumbra from pH-Weighted MRI

Defining an Acidosis-Based Ischemic Penumbra from pH-Weighted MRI

Current knowledge on the neuroprotective and neuroregenerative properties of citicoline in acute ischemic stroke

Magnetic Resonance Characterization of Ischemic Tissue Metabolism

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