Abstract

Although approximately 500,000 patients suffer from stroke each year in the United States, treatment of these patients to date has consisted primarily of prevention, supportive measures, and rehabilitation [1–3]. The modification of surgical procedures to restore adequate blood flow to areas of ischemia in the brain has initiated the need for a more aggressive approach for early diagnosis. It has not been possible to predict which patients with transient ischemic attacks (TIAs) are likely to have a stroke, although major treatment decisions may hinge on this information, since these high-risk groups are known to have substantial risk for developing stroke. The incidence of stroke in TIA patients has been estimated to vary between five to ten per year [4–6]. Patients with global ischemia (cardiac arrest) do not have enough collateral flow, and irreversible neuronal damage commences within four to eight minutes under normal thermic conditions, once the blood flow is acutely blocked [7–10].

Keywords

Permeability Ischemia Neurol Peri Meningitis 

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References

  1. 1.
    Bussuttil RW, Baker JD, Davidson RK, Machleder HI. Carotid artery stenosis: hemodynamic significance and clinical course. JAMA 1981;245:1438–1441.CrossRefGoogle Scholar
  2. 2.
    Fields WS. Progress report of the joint study on extracranial arterial occlusion. In: Millikan CH, Siekert RG, Whisnant JP (eds). Cerebral Vascular Diseases: Fifth Conference. New York: Grune and Stratton, 1966.Google Scholar
  3. 3.
    Meyer FB, Sundt TM Jr, Yanagihara T, Anderson RE. Focal cerebral ischemia: Pathophysiologic mechanisms and rationale for future avenues of treatment. Mayo Clin Proc 1987;62:35–55.PubMedGoogle Scholar
  4. 4.
    Lyons C. Progress report of the joint study on extracranial arterial occlusions. In: Millikan CH, Siekert RG, Whisnant JP (eds). Cerebral Vascular Diseases: Fourth Conference. New York: Grune and Stratton, 1965.Google Scholar
  5. 5.
    Toole JF, Janeway R, Choi K, et al. Transient ischemic attacks due to arteriosclerosis. Arch Neurol 1975; 32:5–12.PubMedGoogle Scholar
  6. 6.
    Zarins CK. Carotid bruit or carotid stenosis: what is the significance? JAMA 1981;245:1462.PubMedCrossRefGoogle Scholar
  7. 7.
    Ames A III, Wright RL, Kowada M, Thurston JM, Majno G. Cerebral ischemia. II. The no-reflow phenomenon. Am J Path 1968;52:437–453.PubMedGoogle Scholar
  8. 8.
    Nemoto EM, Hossmann K-A, Cooper HK. Postishemic hypermetabolism in cat brain. Stroke 1981; 12:666–676.PubMedCrossRefGoogle Scholar
  9. 9.
    Kabat H, Dennis C, Baker AB. Recovery of function following arrest of the brain circulation. Am J Physiol 1941;132:737–747.Google Scholar
  10. 10.
    Hossmann K-A, Olsson Y. Suppression and recovery of neuronal function in transient cerebral ischemia. Brain Res 1970;22:313–325.PubMedCrossRefGoogle Scholar
  11. 11.
    Morawetz RB, Crowell RH, DeGirolami U, Marcoux FW, Jones TH, Halsey JH. Regional cerebral blood flow thresholds during cerebral ischemia. Fed Proc 1979;38:2493–2494.PubMedGoogle Scholar
  12. 12.
    Meyer FB, Anderson RE, Sundt TM Jr, Yaksh TL. Intracellular brain pH, indicator tissue perfusion, electroencephalography, and histology in severe and moderate focal cortical ischemia in the rabbit. J Cereb Blood Flow Metab 1986;6:71–78.PubMedCrossRefGoogle Scholar
  13. 13.
    Crowell RM, Olsson Y, Klatzo I, Ommaya A. Temporary occlusion of the middle cerebral artery in the monkey: clinical and pathological observations. Stroke 1970;1:439–448.PubMedCrossRefGoogle Scholar
  14. 14.
    Sutin JA. Clinical presentation of stroke syndromes. In: Kaplan PE, Cerullo LJ (eds). Stroke Rehabilitation. Stoneham, MA: Butterworth, 1986:1–36.Google Scholar
  15. 15.
    Mohr JP. Lacunes. Stroke 1982;13:3–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Millikan CH. Transient cerebral ischemia: definition and natural history. Prog Cardiovasc Dis 1980;22: 303–308.PubMedCrossRefGoogle Scholar
  17. 17.
    Iannotti F, Hoff JT, Schielke GP. Brain tissue pressure in focal cerebral ischemia. J Neurosurg 1985;62:83–89.PubMedCrossRefGoogle Scholar
  18. 18.
    Little JR, Sundt TM Jr, Kerr FWL. Neuronal alterations in developing cortical infarction: an experimental study in monkeys. J Neurosurg 1974;40: 186–198.PubMedCrossRefGoogle Scholar
  19. 19.
    Sundt TM Jr, Grant WC, Garcia JH. Restoration of middle cerebral artery flow in experimental infarction. J Neurosurg 1969;31:311–322.PubMedCrossRefGoogle Scholar
  20. 20.
    Olsson Y, Crowell RM, Klatzo I. The blood-brain barrier to protein tracers in focal cerebral ischemia and infarction caused by occlusion of the middle cerebral artery. Acta Neuropathol (Berlin) 1971;18:89–102.PubMedCrossRefGoogle Scholar
  21. 21.
    Plum F, Posner JB, Alvord EC Jr. Edema and necrosis in experimental cerebral infarction. Arch Neurol 1963;9:563–670.Google Scholar
  22. 22.
    McDowell FH, Potes J, Groch S. The natural history of internal carotid and vertebral-basilar artery occlusion. Neurology (Minneapolis) 1961; 11(2): 153–157.PubMedGoogle Scholar
  23. 23.
    Oxbury JM, Greenhall RCD, Grainger KMR. Predicting the outcome of stroke: acute stage after cerebral infarction. Br Med J 1975;3:125–127.PubMedCrossRefGoogle Scholar
  24. 24.
    Meyer FB, Piepgras DG, Sundt TM Jr, Yanagihara T. Emergency embolectomy for acute occlusion of the middle cerebral artery. J Neurosurg 1985;62:639–647.PubMedCrossRefGoogle Scholar
  25. 25.
    Meyer FB, Sundt TM Jr, Piepgras DG, Sandok BA, Forbes G. Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits. Ann Surg 1986;203:82–89.PubMedCrossRefGoogle Scholar
  26. 26.
    Davis KR, Taveras JM, New PFJ, Schnur JA, Roberson GH. Cerebral infarction diagnosis by computerized tomography. AJR 1975;124:643–660.Google Scholar
  27. 27.
    Masdeu JC, Azar-Bia B, Rubino FA. Evaluation of recent cerebral infarction by computerized tomography. Arch Neurol 1977;34:417–421.PubMedGoogle Scholar
  28. 28.
    Uemura K, Fukasawa H, Takahashi S. Computed tomography and pathology of cerebrovascular disease. 3- Cerebral infarction: its CT findings and pathological background. Progr Comput Tomogr (Tokyo) 1981;2: 533–543.Google Scholar
  29. 29.
    Yock DH, Marshall WH. Recent ischemic brain infarcts at computed tomography: Appearance pre-and postcontrast infusion. Radiology 1975; 117:599–608.PubMedGoogle Scholar
  30. 30.
    Norton GA, Kishore PRS, Lin J. CT contrast enhancement in cerebral infarction. AJR 1978; 131: 881–885.PubMedGoogle Scholar
  31. 31.
    Larson EB, Omenn GS, Loop JW. Computerized tomography in patients with cerebrovascular disease; impact of a new technology on patient care. AJR 1978;131:35–40.PubMedGoogle Scholar
  32. 32.
    Davis KR, Ackerman RH, Kistler JP, Mohr JP. Computed tomography of cerebral infarction: Hemorrhagic, contrast enhancement, and time of appearance. Comput Tomogr 1977;1:71–86.PubMedCrossRefGoogle Scholar
  33. 33.
    Yamamoto Y, Satoh T, Asari S, Sadamoto K. Normal anatomy of cerebral vessels by computed angiotomo-graphy in the axial transverse plane. J Comput Assist Tomogr 1982;6:865–873.PubMedCrossRefGoogle Scholar
  34. 34.
    Mikhael MA. Neuroradiology of stroke. In: Kaplan PE, Cerullo LJ (eds). Stroke Rehabilitation. Stoneham, MA: Butterworth, 1986:37–80.Google Scholar
  35. 35.
    Caplan LR. Care of the patient with acute stroke. In: Kaplan PE, Cerullo LJ (eds). Stroke Rehabilitation. Stoneham, MA: Butterworth, 1986:81–93.Google Scholar
  36. 36.
    Kertesz A, McCabe P. Recovery patterns and prognosis in aphasia. Brain 1977;100:1–18.PubMedCrossRefGoogle Scholar
  37. 37.
    Spetzler RF. Extracranial-intracranial arterial anastomosis for cerebrovascular disease. Surg Neurol 1979; 11:157–161.PubMedGoogle Scholar
  38. 38.
    Wing SD, Norman D, Pollock JA, Newton TH. Contrast enhancement of cerebral infarcts in computed tomography. Radiology 1976;121:89–92.PubMedGoogle Scholar
  39. 39.
    Mikhael MA. Computerized tomography and brain tumors: a retrospective—prospective review. Semin Neurol 1981;1:137–148.CrossRefGoogle Scholar
  40. 40.
    Kendall BE, Pullicino P. Intravascular contrast injection in ischemic lesions: Effect on prognosis. Neuroradiology 1980;19:241–243.PubMedGoogle Scholar
  41. 41.
    Djang WT, Drayer BP. Intracranial occlusive vascular disease. In: Taveras JM, Ferrucci JT (eds). Radiology: Diagnosis-Imaging-lntervention. Volume 3: Neuroradiology—Head & Neck. Philadelphia J.B. Lippin-cott, 1987:1–17.Google Scholar
  42. 42.
    Zimmerman RA, Bilaniuk LT. Computed tomography of acute intratumoral hemorrhage. Radiology 1980; 135:355–359.PubMedGoogle Scholar
  43. 43.
    Holland GN, Hawkes RC, Moore WS. Nuclear magnetic resonance (NMR) tomography of the brain: coronal and sagittal sections. J Comput Assist Tomogr 1980;4:429.PubMedCrossRefGoogle Scholar
  44. 44.
    Young IR, Burl M, Clarke GJ, et al. Magnetic resonance properties of hydrogen: imaging the posterior fossa. AJR 1981;137:895–901.PubMedGoogle Scholar
  45. 45.
    Brant-Zawadzki M, Davis PL, Crooks LE, et al. NMR demonstration of cerebral abnormalities: comparison with CT. AJR 1983;140:847–854.PubMedGoogle Scholar
  46. 46.
    Buonanno FS, Pykett IL, Kistler JP, et al. Cranial anatomy and detection of ischemic stroke in the cat by nuclear magnetic resonance imaging. Radiology 1982; 143:187–193.PubMedGoogle Scholar
  47. 47.
    DeWitt LD, Grek AJ, Buonanno FS, Levine DN, Kistler JP. MRI and the study of aphasia. Neurology 1985;35:861–865.PubMedGoogle Scholar
  48. 48.
    Levy RM, Mano I, Brito A, Hosobuchi Y. NMR imaging of acute experimental cerebral ischemia: Time course and pharmacologic manipulations. AJNR 1983;4:238–241.PubMedGoogle Scholar
  49. 49.
    Young IR, Randell CP, Kaplan PW, et al. Nuclear magnetic resonance (NMR) imaging in white matter disease of the brain using spin-echo sequences. J Comput Assist Tomogr 1983;7:290.PubMedCrossRefGoogle Scholar
  50. 50.
    Bryan RN, Willcott MR, Schneiders NJ, et al. Nuclear magnetic resonance evaluation of stroke. Radiology 1983;149:189–192.PubMedGoogle Scholar
  51. 51.
    Sipponen JR, Kaste M, Ketonen L, et al. Serial nuclear magnetic resonance (NMR) imaging in patients with cerebral infarction. J Comput Assist Tomogr 1983; 7:585.PubMedGoogle Scholar
  52. 52.
    Bradley WG. NMR imaging of the central nervous system. Neurol Res 1984;6:91.PubMedGoogle Scholar
  53. 53.
    Kato H, Kogure K, Ohtomo H, Tobita M, Matsui S, Yamamoto E, Kohno H. Correlations between proton nuclear magnetic resonance imaging and retrospective histochemical images in experimental cerebral infarction. J Cereb Blood flow Metab 1985;5(2):267–274.PubMedCrossRefGoogle Scholar
  54. 54.
    Bryan RN, Willcott MR, Schneiders NJ, Rose JE. NMR evaluation of stroke in the rat. AJNR 1983;4: 242.PubMedGoogle Scholar
  55. 55.
    Levy RM, Mano I, Brito A, Hosobuchi Y. NMR imaging of acute experimental cerebral ischemia: time course and pharmacologic manipulations. AJNR 1983; 4:238.PubMedGoogle Scholar
  56. 56.
    Buonanno FS, Pykett IL, Brady TJ, et al. Proton NMR imaging in experimental ischemic infarction. Stroke 1983;14:177–184.CrossRefGoogle Scholar
  57. 57.
    Heiss W-D, Herholz K, Bocher-Schwarz HG, Pawlik G, Wienhard K, Steinbrich W, Friedmann G. PET, CT, and MR imaging in cerebrovascular disease. J Comput Assist Tomogr 1986;10(6):903–911.PubMedCrossRefGoogle Scholar
  58. 58.
    Kinkel WR, Jacobs L, Polachini I, Bates V, Heffner RR Jr. Subcortical arteriosclerotic encephalopathy (Biswanger’s disease). Computed tomographic, nuclear magnetic resonance, and clinical correlations. Arch Neurol 1985;42:951–959.PubMedGoogle Scholar
  59. 59.
    Kistler JP, Buonanno JS, DeWitt LD, David KR, Brady TJ, Fisher CM. Vertebral-basilar posterior cerebral territory stroke—delination by proton nuclear magnetic resonance imaging. Stroke 1984; 15:417–426.PubMedCrossRefGoogle Scholar
  60. 60.
    Bradley WG, Waluch V, Brant-Zawadzki M, et al. Patchy, periventricular white matter lesions in the elderly: a common observation during NMR imaging. Noninv Med Imaging 1984; 1:35.Google Scholar
  61. 61.
    Elliott D, Vacca JG, Wehrli FW. Basic principles of magnetic resonance imaging. In: Mettler FA Jr, Muiroff LR, Kulkami MV (eds). Magnetic Resonance Imaging and Spectroscopy. New York: Churchill Livingstone, 1986:1–41.Google Scholar
  62. 62.
    DeLaPaz RL, New PFJ, Buonanno FS, et al. NMR imaging of intracranial hemorrhage. J Comput Assist Tomogr 1984;8:599.PubMedCrossRefGoogle Scholar
  63. 63.
    Wintrobe MM (ed). Clinical Hematology. Philadelphia: Lea& Febiger, 1981.Google Scholar
  64. 64.
    Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT. Intracranial hematomas: imaging by high-field MR. Radiology 1985;157:87–93.PubMedGoogle Scholar
  65. 65.
    Wehrli FW, MacFall JR, Shutts D, et al. Mechanisms of contrast in NMR imaging. J Comput Assist Tomogr 1984;8:369.PubMedCrossRefGoogle Scholar
  66. 66.
    Carr DH, Brown J, Bydder GM, et al. Gadolinium-DTPA as a contrast agent in MRI: initial clinical experience in 20 patients. AJR 1984;143:215–224.PubMedGoogle Scholar
  67. 67.
    Klatzo I, Piraux A, Laskowski EJ. The relationship between edema, blood—brain barrier and tissue elements in a local brain injury. J Neuropathol Exp Neurol 1958;17:548–564.PubMedCrossRefGoogle Scholar
  68. 68.
    Virapongse C, Mancuso A, Quisling R. Human brain infarcts: GD-DTPA-enhanced MR imaging. Radiology 1986;161:785–794.PubMedGoogle Scholar
  69. 69.
    Carr DH, Brown J, Leung W-L, Pennock JM. Iron and gadolinium chelates as contrast agents in NMR imaging: preliminary studies. J Comput Assist Tomogr 1984;8:385.PubMedCrossRefGoogle Scholar
  70. 70.
    McNamara MT, Brant-Zawadzki M, Berry I, et al. Acute experimental cerebral ischemia: MRI enhancement using Gd-DTPA. Radiology 1986; 158:701–704.PubMedGoogle Scholar
  71. 71.
    Runge VM, Stewart RG, Clanton JA, Jones MM, Lukehart CM, Partain CL, James AE Jr. Work in progress: potential oral and intravenous paramagnetic NMR contrast agents. Radiology 1983; 147:789–791.PubMedGoogle Scholar
  72. 72.
    Moniz E. Ľangiographic cerebrale. Paris: Masson et Cie, 1934.Google Scholar
  73. 73.
    Brant-Zawadzki M, Gould R, Norman D, Newton TH, Lane B. Digital subtraction cerebral angiography by intraarterial injection: comparison with conventional angiography. AJNR 1982;3:593–599.Google Scholar
  74. 74.
    Chilcote WA, Modic MT, Pavlicek WA, Little JR, Furlan AJ, Duchesneau PM, Weinstein MA. Digital subtraction angiography of the carotid arteries: a comparative study in 100 patients. Radiology 1981; 139:287–295.PubMedGoogle Scholar
  75. 75.
    Toole JF, Janeway R, Choi K, et al. Transient ischemic attacks due to arteriosclerosis. Arch Neurol 1975;32:5–12.PubMedGoogle Scholar
  76. 76.
    Lyons C. Progress report of the joint study on extracranial arterial occlusions. In: Millikan CH, Siekert RG, Whisnant JP (eds). Cerebral Vascular Diseases: Fourth Conference. New York: Grune and Stratton, 1965.Google Scholar
  77. 77.
    Martin MJ, Sayre GP, Whisnant JP. Incidence of occlusive vascular disease in the extracranial arteries contributing to the cerebral circulation. Trans Am Neurol Assoc 1960;85:103–105.PubMedGoogle Scholar
  78. 78.
    Martin MJ, Whisnant JP, Sayre GP. Occlusive vascular disease in the extracranial cerebral circulation. Arch Neurol 1960;3:530–538.PubMedGoogle Scholar
  79. 79.
    Fields WS. Progress report of the joint study on extracranial arterial occlusion. In: Millikan CH, Siekert RG, Whisnant JP (eds). Cerebral Vascular Diseases: Fifth Conference. New York: Grune and Stratton, 1966.Google Scholar
  80. 80.
    Metz H, Murray-Leslie RM, Bannister RG, Bull JWD, Marshall J. Kinking of the internal carotid artery. Lancet 1961;1:424–426.PubMedCrossRefGoogle Scholar
  81. 81.
    Fox JL. Cerebral arterial revascularization: the value of repeated angiography in selection of patients for operation. Neurosurgery 1978;2:205–209.PubMedCrossRefGoogle Scholar
  82. 82.
    Mikhael MA. Transient spasm of carotid siphon complicating ruptured cranial dermoid cyst. Radiology 1982;144:824.PubMedGoogle Scholar
  83. 83.
    O’Leary DH, Persson AV, Clouse ME. Noninvasive testing for carotid artery stenosis. 1. Prospective analysis of three methods. AJNR 1981;2:437–442;Google Scholar
  84. 83a.
    O’Leary DH, Persson AV, Clouse ME. Noninvasive testing for carotid artery stenosis. 1. Prospective analysis of three methods. AJNR 1981;137:1189–1194.Google Scholar
  85. 84.
    Ovitt TW, Christenson PC, Fisher HD III, et al. Intravenous angiography using digital video subtraction. X-ray imaging. AJNR 1980;1:387–390.Google Scholar
  86. 85.
    Mistretta CA, Crummy AB, Strother CM. Digital angiography: a perspective. Radiology 1981; 139:273 – 276.PubMedGoogle Scholar
  87. 86.
    Bradley WG, Waluch V. Blood flow: Magnetic resonance imaging. Radiology 1985;154:443–450.PubMedGoogle Scholar
  88. 87.
    Young IR, Bydder GM, Hall AS, et al. NMR imaging in the diagnosis and management of intracranial angiomas. AJNR 1983;4:837.PubMedGoogle Scholar
  89. 88.
    Worthington BS, Kean DM, Hawkes RC, et al. NMR imaging in the recognition of giant intracranial aneurysms. AJNR 1983;4:835.PubMedGoogle Scholar

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© Kluwer Academic Publishers, Boston 1989

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  • Michael A. Mikhael

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