Review of Critical Care and Emergency Approaches to Stroke

Hanley, Daniel F.

doi:10.1161/01.str.0000054629.76247.ea

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…Thrombolytic agents have been shown to improve outcome for stroke patients with evidence of salvageable tissue (1 ). However, the presence of intracranial hemorrhage (ICH), 3 in which case these agents are contraindicated, must first be ruled out.…”

mentioning

confidence: 99%

Early Biomarkers of Stroke

Reynolds¹,

Kirchick²,

Dahlen³

et al. 2003

Clinical Chemistry

206

134

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Background:The diagnosis and management of acute ischemic stroke are limited by the lack of rapid diagnostic assays for use in an emergency setting. Computed tomography (CT) scanning is used to diagnose hemorrhagic stroke but is relatively ineffective (<33% sensitive) in detecting ischemic stroke. The ability to correlate blood-borne protein biomarkers with stroke phenotypes would aid in the development of such rapid tests. Methods: ELISAs for >50 protein biomarkers were developed for use on a high-throughput robotic workstation. These assays were used to screen plasma samples from 214 healthy donors and 223 patients diagnosed with stroke, including 82 patients diagnosed with acute ischemic stroke. Marker assay values were first compared by univariate analysis, and then the top markers were subjected to multivariate analysis to derive a marker panel algorithm for the prediction of stroke. Results: The top markers from this analysis were S-100b (a marker of astrocytic activation), B-type neurotrophic growth factor, von Willebrand factor, matrix metalloproteinase-9, and monocyte chemotactic protein-1. In a panel algorithm in which three or more marker values above their respective cutoffs were scored as positive, these five markers provided a sensitivity of 92% at 93% specificity for ischemic stroke samples taken within 6 h from symptom onset. Conclusion: A marker panel approach to the diagnosis of stroke may provide a useful adjunct to CT scanning in the emergency setting.

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mentioning

confidence: 99%

Early Biomarkers of Stroke

Reynolds¹,

Kirchick²,

Dahlen³

et al. 2003

Clinical Chemistry

206

134

View full text Add to dashboard Cite

show abstract

“…Clinical studies report that it is maximal between 1 and 3 days following stroke [15], whilst experimental studies report its presence as early as 15 min after the onset of vascular occlusion [19]. Cerebral oedema can lead to an increase in intracranial pressure (ICP), the sequelae of which include reduced cerebral blood flow, further ischaemia and infarct extension, deformation and herniation of the brain tissue, and in severe cases, death [10,14,15,20,21]. With the mortality of malignant cerebral oedema approaching 80% [15,22], the importance of reducing cerebral oedema and the resultant rise in ICP is now widely recognised as a major clinical management target.…”

Section: Secondary Injurymentioning

confidence: 99%

The Role of Substance P in Ischaemic Brain Injury

Turner¹,

Vink²

2013

Brain Sciences

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Stroke is a leading cause of death, disability and dementia worldwide. Despite extensive pre-clinical investigation, few therapeutic treatment options are available to patients, meaning that death, severe disability and the requirement for long-term rehabilitation are common outcomes. Cell loss and tissue injury following stroke occurs through a number of diverse secondary injury pathways, whose delayed nature provides an opportunity for pharmacological intervention. Amongst these secondary injury factors, increased blood-brain barrier permeability and cerebral oedema are well-documented complications of cerebral ischaemia, whose severity has been shown to be associated with final outcome. Whilst the mechanisms of increased blood-brain barrier permeability and cerebral oedema are largely unknown, recent evidence suggests that the neuropeptide substance P (SP) plays a central role. The aim of this review is to examine the role of SP in ischaemic stroke and report on the potential utility of NK1 tachykinin receptor antagonists as therapeutic agents.

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“…When such compensatory mechanisms fail, profound increases in intracranial pressure (ICP) or intrathecal pressure (ITP) may result. The sequelae of elevated ICP/ITP include reduced blood flow to CNS tissue, ischemia and infarct extension, deformation and herniation of the brain and spinal cord tissue, and in severe cases, death [18, 29–31]. …”

Section: Edemamentioning

confidence: 99%

Blocking Neurogenic Inflammation for the Treatment of Acute Disorders of the Central Nervous System

Lewis

Turner

Vink

2013

International Journal of Inflammation

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Classical inflammation is a well-characterized secondary response to many acute disorders of the central nervous system. However, in recent years, the role of neurogenic inflammation in the pathogenesis of neurological diseases has gained increasing attention, with a particular focus on its effects on modulation of the blood-brain barrier BBB. The neuropeptide substance P has been shown to increase blood-brain barrier permeability following acute injury to the brain and is associated with marked cerebral edema. Its release has also been shown to modulate classical inflammation. Accordingly, blocking substance P NK1 receptors may provide a novel alternative treatment to ameliorate the deleterious effects of neurogenic inflammation in the central nervous system. The purpose of this paper is to provide an overview of the role of substance P and neurogenic inflammation in acute injury to the central nervous system following traumatic brain injury, spinal cord injury, stroke, and meningitis.

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Review of Critical Care and Emergency Approaches to Stroke

Cited by 8 publications

References 25 publications

Early Biomarkers of Stroke

Early Biomarkers of Stroke

The Role of Substance P in Ischaemic Brain Injury

Blocking Neurogenic Inflammation for the Treatment of Acute Disorders of the Central Nervous System

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