Stroke pathophysiology: management challenges and new treatment advances

Abstract

J. JORDÁN, I. IKUTA, J. GARCÍA-GARCÍA, S. CALLEJA and T. SEGURA. Stroke pathophysiology: Management challenges and new treatment advances (minireview). J. Physiol. Biochem., 63 (3), 261-278, 2007. Stroke is the second leading cause of death and the first cause of lost disabilityadjusted years in developed countries. During the past decade, new developments in thrombolytic therapy have led to the implementation of emergency intervention protocols for the treatment of ischemic stroke, replacing the widespread sense of therapeutic nihilism in the past. Treatment with rtPA has shown to be effective within the first 3 hours following stroke onset and the FDA and the European Medical Agency (EMEA) have approved its use. Acknowledging the urgency and intricacies of stroke, Stroke Units allow the monitoring of physiological parameters in the acute phase of stroke and are considered an important management tool that can significantly improve the quality of care provided to the patient. The concept of neuroprotective therapy for acute ischemic stroke to salvage tissue at risk and improve functional outcome is based on sound scientific principles and extensive preclinical animal studies demonstrating efficacy. However, most neuroprotective drugs in clinical trials have failed, possibly due to inadequate preclinical testing or flawed clinical development programs. Several new treatment strategies are under development and are being tested. This review is directed at understanding the management of acute ischemic stroke pathophysiology. We address the management challenges and new treatment advances by integrating the knowledge of possible pharmacological targets for acute ischemic stroke. We hope to shed new light upon the controversy surrounding the management of acute ischemic stroke in an attempt to elucidate why failed clinical trials continue to occur despite promising neuroprotective preclinical studies.

Effect of ligustrazine on levels of amino acid neurotransmitters in rat striatum after cerebral ischemia-reperfusion injury

“…Superscript symbols (*) and (**) indicate significant differences from the I/R injury group at P , 0.05 and P , 0.01, respectively. clinical trials in the past decade, the management of cerebral ischemia remains a significant challenge [7]. Recently, a therapeutic potential of traditional Chinese herbal medicine has been proposed for ischemic brain lesions [8].…”

Obesity and Stroke: Does the Paradox Apply for Stroke?

“…14 Depending on injury magnitude, tissue compromise, and opportune medical management, patients can present with multiple lethal complications that may lead to unfavorable outcomes. 17,18 There are multiple risk factors for stroke development like arterial hypertension, hypercholesterolemia, diabetes mellitus, cardiopathy, tobacco or excessive alcohol consumption, environmental air pollution, high-risk diet, and obesity. 12,14,27,[19][20][21][22][23][24][25][26] Obesity is the second leading cause of preventable death (after tobacco) worldwide and is considered a public health problem with a doubled prevalence since the 1980s, due to the globalization of its risk factors and an exponential increase in its consequences.…”

Peripheral Administration of Human Adrenomedullin and Its Binding Protein Attenuates Stroke-Induced Apoptosis and Brain Injury in Rats

“…Injury from ischemic stroke is the result of a complex series of cellular metabolic events that occur rapidly after the interruption of nutrient blood and oxygen to a region of the brain (49). Once blood flow to cerebral neurons diminishes, one or more branching mechanisms may independently lead to brain cell death.…”