Evolving Paradigms for Neuroprotection: Molecular Identification of Ischemic Penumbra
- 1 May 2006
- journal article
- review article
- Published by S. Karger AG in Cerebrovascular Diseases
- Vol. 21 (Suppl. 2), 71-79
- https://doi.org/10.1159/000091706
Abstract
Ischemic penumbra defines the existence of tissue at risk of infarction and which is, hence, potentially salvageable and the target for current stroke reperfusion and neuroprotective therapies. Penumbral tissue evolves toward irreversibly damaged tissue at different rates in individual stroke patients yielding different therapeutic windows depending on the individual duration of risk of infarction of this tissue. An accurate identification of the penumbra is then necessary in order to individualize the window of opportunity for therapeutic interventions. Imaging techniques, although helpful, may not give the most accurate information as to the existence of penumbra given that the threshold for identification of penumbra varies depending on the technique used. A better identification of the true penumbral tissue might be based on the cascade of molecular events that are responsible for the evolution of the penumbra toward infarcted tissue. Multiple penumbras can be defined in molecular terms taking into account which vessel is occluded, the time of evolution of the ischemia, the degree of the ischemia, and the sensitivity to ischemia of the different cells. Future studies are necessary to clarify whether the enhancement of cytoprotective mechanisms, and/or the block of cytotoxic mechanisms confirming the existence of penumbra at different times of ischemic evolution, are effective neuroprotective strategies.Keywords
This publication has 60 references indexed in Scilit:
- Neuregulin-1 is neuroprotective and attenuates inflammatory responses induced by ischemic strokeBiochemical and Biophysical Research Communications, 2004
- Adventures in the Pathophysiology of Brain Ischemia: Penumbra, Gene Expression, NeuroprotectionStroke, 2003
- Neurological Deterioration in Acute Lacunar InfarctionsStroke, 2001
- The Cyclooxygenase-2 Inhibitor NS-398 Ameliorates Ischemic Brain Injury in Wild-Type Mice but not in Mice with Deletion of the Inducible Nitric Oxide Synthase GeneJournal of Cerebral Blood Flow & Metabolism, 1999
- Cyclooxygenase‐2 is induced globally in infarcted human brainAnnals of Neurology, 1998
- Neuroexcitatory Amino Acids and Their Relation to Infarct Size and Neurological Deficit in Ischemic StrokeStroke, 1996
- Medical Therapy for Ischemic StrokeClinical Neuropharmacology, 1996
- Treatment of Acute Ischemic StrokeStroke, 1995
- Focal ischemia causes an extensive induction of immediate early genes that are sensitive to MK-801.Stroke, 1994
- The Effect of MK-801 on Cortical Spreading Depression in the Penumbral Zone following Focal Ischaemia in the RatJournal of Cerebral Blood Flow & Metabolism, 1992