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Cerebral Blood Flow pp 137–146Cite as

The Ischemic Penumbra: Pathophysiology and Therapeutic Implications

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Part of the book series: Update in Intensive Care Medicine ((UICMSOFT,volume 37))

Abstract

Under physiological conditions the brain covers its energy demands almost exclusively by oxidation of glucose. Opitz and Schneider [1] were the first to point out that an impairment of energy production induced by constrained oxygen supply affects the energy-consuming processes in a sequential way: first the functional activity of the brain is impaired followed,at a more severe degree of hypoxia, by the suppression of the metabolic activity required to maintain its structural integrity. The concept of two different thresholds of hypoxia for the preservation of functional and structural integrity was later refined by Symon et al. [2] who used a model of focal ischemia to establish the respective rates of blood flow. These studies revealed that EEG and evoked potentials are disturbed at substantially higher flow rates than the potassium gradient across the plasma membranes. Since the preservation of this gradient is a sign of cell viability, Symon and his colleagues proposed that neurons located in the flow range between “electrical” and “membrane” failure are functionally silent but structurally intact. In focal ischemia, this flow range corresponds to a coronal region intercalated between the necrotic infarct core and the normal brain; it has been termed “penumbra” in analogy to the partly illuminated area around the complete shadow of the moon in full eclipse [3].

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  1. Department of Experimental Neurology, Max Planck Institute of Neurological Research, Cologne, Germany

    Konstantin-Alexander Hossmann MD

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© 2003 Kluwer Academic/Plenum Publishers, New York

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Hossmann, KA. (2003). The Ischemic Penumbra: Pathophysiology and Therapeutic Implications. In: Cerebral Blood Flow. Update in Intensive Care Medicine, vol 37. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56036-1_10

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  • DOI: https://doi.org/10.1007/978-3-642-56036-1_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-42684-4

  • Online ISBN: 978-3-642-56036-1

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