Infratentorial Strokes for Posterior Circulation Folks: Clinical Correlations for Current Translational Therapeutics

Abstract

Approximately 20 percent of all strokes will occur in the Infratentorial brain. This is within the vascular territory of the posterior vascular circulation. Very few clinical specifics are known about the therapeutic needs of this patient sub-population. Most evidence-based practices are founded from research about the treatment of anterior circulatory stroke. As a consequence, little is known about how stroke in the Infratentorial brain region would require a different approach. We characterized the neurovascular features of Infratentorial stroke, pathophysiological responses, and experimental models for further translational study.

Evaluation of the hematoma consequences, neurobehavioral profiles, and histopathology in a rat model of pontine hemorrhage

“…42,63,64,67,104 Notwithstanding, clinical cognitive dysfunction following brainstem hemorrhage in humans remains a weakly reported fact in the literature, 74,88 and our study further highlights the novelty and importance of using such a rodent ICH model to examine an important clinical outcome of which little is known. 22 However, in terms of specifically why cognitive deficits were observed following pontine hemorrhage, one can only speculate.…”

“…25,72,73 To highlight the differences, compared with the more common basal ganglia hemorrhages (ICH) having less than 50% mortality rates, 7 PPH is highly lethal, leading to a mortality rate in excess of 65%. 15,31,137 This much greater severity is likely related to the many ascending and descending brainstem projections connected with the reticular formation, cardiovascular, and respiratory centers (reviewed by Lekic et al 63 ). Current therapeutic approaches following PPH, however, are largely based on outcomes found in basal ganglia hemorrhage.…”

Digital 3D Brain MRI Arterial Territories Atlas

“…Recently, Kim et al 20 used a large dataset of stroke patients from academic centers in Korea to map supratentorial cerebral arterial territories. Despite its strengths, infratentorial and deep perforating arterial territories were not defined, even though approximately 20% of all strokes occur in both the infratentorial 26 and deep perforating arterial zones 27 . Furthermore, a publicly accessible electronic version of the atlas is not available, thus reducing applicability.…”

“…As for the non-linear transformation, there are two important parameters, sigma and iterationsnonlinear (N_iter), to determine the smoothness of the displacement field and the number of iteration steps. To find the optimal sigma and N_iter, we "hyperparameter-searched" all the combinations of sigma in [1,3,5] and N_iter in [10,15,20] to register a set of 470 subjects with "not visible" strokes to the template. We evaluated the deformation results for each combination of parameters across all subjects, as follows:…”

Posterior Circulation Stroke: Animal Models and Mechanism of Disease

“…This leads to evidence-based guidelines which may not sufficiently represent some important spectrums of stroke. For these reasons, experimental animal models could be a useful tool to address emerging posterior circulation treatment strategies [ 8 ]. In this paper, we will integrate clinical features with animal models in describing characteristics of posterior circulation strokes, including the neurovascular features, and pathophysiology mechanisms founded from these experimental models.…”