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Related Concept Videos

Ischemic Stroke ll: Pathophysiology01:15

Ischemic 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...
Ischemic Stroke l: Introduction01:15

Ischemic 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.
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Transient Ischemic Attack l: Introduction01:26

Transient 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...

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Related Experiment Video

Updated: May 9, 2026

Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
12:15

Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion

Published on: February 17, 2013

Redefining the Cerebral Ischemic Core-Penumbra-Oligemia Continuum.

Umberto Pensato1,2, Johanna M Ospel3, Aravind Ganesh4

  • 1Neuro Center, IRCCS Humanitas Research Hospital, Milan, Italy (U.P.).

Stroke
|May 8, 2026
PubMed
Summary

The traditional ischemic core-penumbra model for acute stroke may oversimplify tissue damage. A new 6-level continuum model offers a more nuanced view of ischemic progression and clinical implications.

Keywords:
infarctionperfusionreperfusionstrokethrombectomy

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Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion
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Two-vessel Occlusion Mouse Model of Cerebral Ischemia-reperfusion
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Two-vessel Occlusion Mouse Model of Cerebral Ischemia-reperfusion

Published on: March 1, 2019

Area of Science:

  • Neurology
  • Pathophysiology
  • Medical Imaging

Background:

  • Acute ischemic stroke involves complex, dynamic tissue damage evolving at varying rates.
  • The traditional binary ischemic core-penumbra model simplifies infarct evolution but may miss clinical nuances.
  • Current models struggle to fully explain the spectrum of outcomes with reperfusion therapies.

Purpose of the Study:

  • Critically appraise existing pathophysiology and clinical concepts of infarct evolution in acute ischemic stroke.
  • Challenge the traditional compartmentalization of ischemic core, penumbra, and oligemia.
  • Propose a more granular pathophysiological tissue concept to better reflect ischemic progression.

Main Methods:

  • Critical review of existing literature on ischemic stroke pathophysiology and clinical concepts.
  • Analysis of evidence challenging the conventional core-penumbra hypothesis.
  • Development of a modified 6-level core-penumbra-oligemia continuum model.

Main Results:

  • Mounting evidence challenges the deterministic assumptions of the core-penumbra hypothesis.
  • Automated image processing may oversimplify stroke pathophysiology.
  • A 6-level continuum (benign oligemia, vulnerable oligemia, durable penumbra, critical penumbra, nonleaky core, leaky core) is proposed.

Conclusions:

  • The proposed 6-level continuum better reflects pathological ischemic changes and vulnerability.
  • This granular classification can enhance understanding of tissue fate and infarct evolution.
  • The framework aims to inform treatment decisions and refine therapeutic targeting in ischemic stroke.