Without adequate blood supply and thus lack of oxygen, brain cells lose their ability to produce energy - particularly adenosine triphosphate (ATP).(Source: ) Important steps of the ischaemic cascade The goal of acute stroke therapy is to normalise perfusion and intervene in the cascade of biochemical dysfunction to salvage the penumbra as much and as early as possible.Īlthough it is called a cascade, events are not always linear (figure 2).
THEBRAIN 9 FORUM SERIES
This is a series of biochemical reactions in the brain and other aerobic tissues, which usually goes on for two to three hours, but can last for days, even after normal blood flow returns. Figure 1: Ischaemic penumbra – Potential to reverse neurologic impairment with post-stroke therapyĪfter seconds to minutes of cerebral ischaemia, the ischaemic cascade is initiated. They may undergo apoptosis after several hours or days but if blood flow and oxygen delivery is restored shortly after the onset of stroke, they are potentially recoverable (figure 1). Cells in this area are endangered but not yet irreversibly damaged. This region is rendered functionally silent by reduced blood flow but remains metabolically active. The tissue in the region bordering the infarct core, known as the ischaemic penumbra, is less severely affected. In the core area of a stroke, blood flow is so drastically reduced that cells usually cannot recover and subsequently undergo cellular death.
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