Stroke Research Priorities for the Next Decade – A Representative View of the European Scientific Community

Blood—Brain Barrier Breakdown Involves Four Distinct Stages of Vascular Damage in Various Models of Experimental Focal Cerebral Ischemia

“…Although the mechanisms underlying BBB breakdown under pathologic conditions were recently rated as high priority for stroke research, 18 related pathophysiologic processes associated with hemorrhagic transformation and cerebral hemorrhage, especially after reconstitution of cerebral blood flow, are still poorly understood. Given the fact that in recent years recanalization using rt-PA was applied more frequently and in a broader time window from ischemia onset, detailed knowledge on BBB breakdown in naive ischemia and in the setting of reperfusion becomes increasingly important to develop neuroprotective strategies that could be coadministered to rt-PA. 33 In line with our previous work that showed endothelial damage as a potential mechanism for BBB breakdown in a thromboembolic model of focal cerebral ischemia, 14 we here investigated alterations in endothelial cells as well as associated TJs and AJ in diverse animal models of ischemic stroke including transient ischemia to evaluate putative effects of reperfusion on the vasculature.…”

“…In fact, loss of the barrier function as indicated by hemorrhagic transformation or even intracranial bleeding is frequently observed after therapeutical recanalization via recombinant tissue plasminogen activator (rt-PA), which still represents the only FDA-approved drug-related therapy. 17,18 These complications were traditionally attributed to a reperfusion-mediated vascular damage, [19][20][21] which is commonly addressed as 'reperfusion injury'. 22,23 As clinical treatment strategies tend to apply recanalization via rt-PA more frequently and in a broader time window from ischemia onset, knowledge of the underlying mechanisms for ischemia-related BBB breakdown, especially in a clinically relevant setting of reperfusion, may be of particular interest for the development of neuroprotective strategies in combination with rt-PA.…”

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

“…1 This plasticity is exploited by rehabilitation which is effective at improving outcome, and it might be possible to enhance this recovery further using pharmacological means, 2 an approach that has been referred to as 'pharmacological rehabilitation. 3,4 In experimental models cerebral ischaemia results in a catecholamine deficit, whereas drugs that negatively regulate central neurotransmitters, such as haloperidol, (a dopamine receptor antagonist), have detrimental affects on outcome in both experimental and clinical stroke.…”

Occupational therapy and neuromotor interventions

“…In the United States, stroke is the leading cause of long-term disability, with approximately 795,000 strokes per year (Centers for Disease Control and Prevention, 2009). About 1 million people in the European Union (Meairs et al, 2006) annually suffer a stroke. Unfortunately, health experts anticipate that the number of those suffering a stroke will continue to increase, particularly in developing countries, because of increased aging populations and exposure to major risk factors (Meairs et al, 2006).…”

“…About 1 million people in the European Union (Meairs et al, 2006) annually suffer a stroke. Unfortunately, health experts anticipate that the number of those suffering a stroke will continue to increase, particularly in developing countries, because of increased aging populations and exposure to major risk factors (Meairs et al, 2006). Corresponding to this increase will be a need for evidencebased occupational therapy intervention.…”