Salvaging The Ischaemic Penumbra: More Than Just Reperfusion?

Salvaging The Ischaemic Penumbra: More Than Just Reperfusion? SUMMARY 1. The ischaemic penumbra is defined as a moderately hypoperfused region that retains structural integrity but has lost function. In animal models of ischaemic stroke, this region is prone to recurrent anoxic depolarization and will become infarcted if reperfusion does not occur. In the macaque model, an ischaemic penumbra has been identified for up to 3 h after ischaemic stroke onset, whereas in selected human patients it may exist for up to 48 h. 2. Although most definitions of the ischaemic penumbra stress a ‘time–brain volume’ concept, few incorporate the idea that selective and delayed neuronal injury plays an important role. Thus, in addition to necrotic cell death caused by acute injury, it is important to also consider delayed death mediated by caspase‐dependent and ‐independent apoptotic pathways. 3. ‘Salvage’ of penumbral tissue is possible if reperfusion (e.g. after thrombolysis) occurs. However, neurons within this ‘salvaged’ region may be still at risk of further delayed neuronal injury. 4. In the present review, we aim to revisit the concept of the ischaemic penumbra and explore the role of selective and delayed neuronal injury in enlargement of the volume of infarction, as well as pathogenic mechanisms of white matter ischaemia. Both animal and human models of cerebral ischaemia imaged using magnetic resonance and positron emission tomography techniques will be discussed. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical and Experimental Pharmacology and Physiology Wiley

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Publisher
Wiley
Copyright
Copyright © 2002 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0305-1870
eISSN
1440-1681
D.O.I.
10.1046/j.1440-1681.2002.03609.x
Publisher site
See Article on Publisher Site

Abstract

SUMMARY 1. The ischaemic penumbra is defined as a moderately hypoperfused region that retains structural integrity but has lost function. In animal models of ischaemic stroke, this region is prone to recurrent anoxic depolarization and will become infarcted if reperfusion does not occur. In the macaque model, an ischaemic penumbra has been identified for up to 3 h after ischaemic stroke onset, whereas in selected human patients it may exist for up to 48 h. 2. Although most definitions of the ischaemic penumbra stress a ‘time–brain volume’ concept, few incorporate the idea that selective and delayed neuronal injury plays an important role. Thus, in addition to necrotic cell death caused by acute injury, it is important to also consider delayed death mediated by caspase‐dependent and ‐independent apoptotic pathways. 3. ‘Salvage’ of penumbral tissue is possible if reperfusion (e.g. after thrombolysis) occurs. However, neurons within this ‘salvaged’ region may be still at risk of further delayed neuronal injury. 4. In the present review, we aim to revisit the concept of the ischaemic penumbra and explore the role of selective and delayed neuronal injury in enlargement of the volume of infarction, as well as pathogenic mechanisms of white matter ischaemia. Both animal and human models of cerebral ischaemia imaged using magnetic resonance and positron emission tomography techniques will be discussed.

Journal

Clinical and Experimental Pharmacology and PhysiologyWiley

Published: Jan 14, 2002

References

  • The ischemic penumbra, injury thresholds, and the therapeutic window for acute stroke.
    Ginsberg, Ginsberg; Pulsinelli, Pulsinelli
  • Hyperacute stroke. Simultaneous measurement of relative cerebral blood volume, relative cerebral blood flow, and mean tissue transit time.
    Sorensen, Sorensen; Copen, Copen; Ostergaard, Ostergaard
  • Proton MR spectroscopy in acute middle cerebral artery stroke.
    Gillard, Gillard; Barker, Barker; Van Zijl, Van Zijl; Bryan, Bryan; Oppenheimer, Oppenheimer
  • Reversal of acute apparent diffusion coefficient abnormalities and delayed neuronal death following transient focal cerebral ischemia in rats.
    Li, Li; Han, Han; Tatlisumak, Tatlisumak

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