Acute ischaemic stroke: part I. The carotid circulation
1Department of Critical Care Medicine, Flinders Medical Centre, Adelaide, South Australia.
Summary
Recent advances in acute ischaemic stroke management show aspirin and specialized unit care reduce mortality. However, thrombolytic and neuroprotective therapies have limited proven benefit for stroke patients.
Area of Science:
- Neurology
- Cardiovascular Medicine
Background:
- Acute ischaemic stroke presents with rapid neurological deficits due to arterial circulation thrombosis or embolism.
- Timely diagnosis is crucial, often requiring urgent computed tomography (CT) to distinguish from haemorrhagic stroke.
Purpose of the Study:
- To review recent advancements in managing acute ischaemic stroke.
- To present a two-part overview of current treatment strategies and emerging therapies.
Main Methods:
- A MEDLINE search of English-language literature from 1990 to 2000 identified relevant studies.
- Review focused on articles and studies concerning acute ischaemic stroke management.
Main Results:
- Aspirin (150-300 mg) within 48 hours and specialized stroke unit care significantly reduce morbidity and mortality.
- Advanced imaging like MRI, angiography, and Doppler ultrasonography aid in lesion assessment.
- Investigational therapies like thrombolytics and neuroprotective agents have shown experimental promise but lack consistent clinical improvement in outcomes.
Conclusions:
- For carotid circulation strokes, daily aspirin (150-300 mg) and acute stroke unit management are recommended.
- Thrombolytic therapy, such as recombinant tissue plasminogen activator (rt-PA) within three hours, has a limited role.
- Current neuroprotective agents have not demonstrated significant clinical benefit in improving stroke outcomes.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:26Arteries of the Head and Neck
The human body's intricate network of arteries ensures that every organ system receives the necessary oxygen and nutrients for optimal function. The arterial network in the head and neck region is particularly complex, providing vital blood flow to the brain, eyes, and other critical structures. Prominent arteries in this region include the internal carotid arteries and the vertebral arteries.
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:10The Arch of Aorta
The coronary arteries, originating from the ascending aorta, bifurcate from two sinuses located within the ascending aorta. Positioned just above the aortic semilunar valve, these sinuses house essential aortic baroreceptors and chemoreceptors, crucial for maintaining cardiac function. The left coronary artery and the right coronary artery branch off from the left posterior and anterior aortic sinuses, respectively.
Encircling the heart, the coronary arteries form a ring-like structure before...
Encircling the heart, the coronary arteries form a ring-like structure before...
01:26Transient Ischemic Attack l: Introduction
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
01:29Stroke: Introduction and Types
A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...