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Ischemic core and penumbra in human stroke

A M Kaufmann1, A D Firlik, M B Fukui

  • 1Department of Clinical Neurosciences, University of Calgary, Alberta, Canada. anthony.kaufmann@crha-health.ab.ca

Stroke
|January 8, 1999
PubMed
Summary

In acute stroke, a severely ischemic core (CBF ≤6) within 1-6 hours predicts final infarction. The surrounding penumbra (CBF 7-20) is narrow, necessitating rapid interventions to save brain tissue.

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Area of Science:

  • Neurology
  • Neuroradiology
  • Cerebrovascular Disease

Background:

  • Characterizing ischemic core and penumbra in acute human stroke is crucial for patient assessment and treatment.
  • Differentiation of viable vs. irreversibly injured brain tissue aids in stroke management.

Purpose of the Study:

  • To characterize the ischemic core and penumbra in patients with acute middle cerebral artery (MCA) occlusion.
  • To correlate early cerebral blood flow (CBF) measurements with final infarct size.

Main Methods:

  • Measured CBF in 20 acute MCA occlusion patients using stable xenon CT within 60-360 minutes of stroke onset.
  • Quantified hemispheric percentages of CBF at various thresholds (30 cm³/100g/min).
  • Assessed follow-up CT scans to determine final infarct area and correlated with initial CBF.

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Main Results:

  • All patients showed areas of CBF ≤20 cm³/100g/min ipsilateral to MCA occlusion.
  • The average ipsilateral area with CBF ≤20 was significantly larger (66% vs. 36%) than the contralateral side (P<0.001).
  • The severely ischemic core (CBF ≤6) correlated strongly with the final infarct area (r=0.866, P<0.01), while the penumbra (CBF 11-20) was similar bilaterally.

Conclusions:

  • A severely ischemic core (CBF ≤6) within 1-6 hours post-stroke predicts infarction in human MCA occlusion.
  • The ischemic penumbra (CBF 7-20) surrounding the core is narrow, limiting therapeutic time windows.
  • Effective stroke treatment strategies require rapid reperfusion or enhanced cerebral ischemia tolerance.