Acute ischaemic

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Acute Ischaemic Stroke: Pathophysiology, Complications, and Management

Pathophysiology of Acute Ischaemic Stroke

Keywords: acute ischaemic stroke, cerebral blood flow, infarction

Acute ischaemic stroke (AIS) is a condition where a critical reduction in cerebral blood flow leads to brain tissue infarction. This type of stroke accounts for nearly 90% of all stroke cases and is a leading cause of death and disability worldwide. The primary injury occurs within the first few hours, emphasizing the importance of early intervention to restore blood flow and minimize brain damage.

Infection and Inflammation in Acute Ischaemic Stroke

Keywords: infection, inflammation, immune response

Infection plays a significant role in the context of AIS. It can act as a trigger for stroke, with up to a third of ischaemic strokes being preceded by an infection. Post-stroke infections, such as pneumonia and sepsis, complicate recovery and can worsen outcomes. The inflammatory response, while a defense mechanism against infection, can also contribute to stroke pathology and neurological damage. Understanding the interplay between inflammation, infection, and ischaemic mechanisms is crucial for developing new treatment strategies that modulate the immune response.

Complications and Predictors of Neurological Deterioration

Keywords: neurological deterioration, predictors, complications

Early neurological deterioration (END) within 24 hours of AIS is a serious event with significant implications for patient outcomes. The incidence of END varies, with hyperglycaemia, lack of prior aspirin use, and large infarcts being consistent predictors. END is often associated with poor outcomes and can be caused by factors such as intracranial hemorrhage and malignant edema. Systemic complications like deep venous thrombosis and pulmonary embolism also pose risks during the recovery phase.

Diabetes, Hyperglycaemia, and Stroke Outcomes

Keywords: diabetes, hyperglycaemia, stroke outcomes

Diabetes significantly increases the risk of AIS, with diabetic individuals having more than double the risk compared to non-diabetics. Hyperglycaemia, present in 30-40% of AIS patients, is linked to poor functional outcomes due to its potential to exacerbate ischaemic damage. The management of blood glucose levels in the early stages of stroke is challenging, and ongoing studies are investigating the efficacy of glucose-lowering treatments.

Therapeutic Strategies and Management

Keywords: reperfusion therapy, thrombolysis, thrombectomy

Timely reperfusion treatment is the cornerstone of effective AIS management. Intravenous thrombolysis and endovascular thrombectomy are standard treatments that have significantly improved patient outcomes. These therapies aim to achieve recanalization and reperfusion of the ischaemic penumbra, thereby minimizing brain damage. Advanced neuroimaging criteria now allow these treatments to be applied in extended time windows and to a broader range of patients.

Emerging Treatments: Hypothermia and Haemodilution

Keywords: hypothermia, haemodilution, neuroprotection

Hypothermia has shown promise in improving neurological outcomes by affecting multiple pathways in the ischaemic cascade. When combined with reperfusion strategies, hypothermia may offer synergistic benefits. Haemodilution, aimed at improving blood flow to the affected brain areas, has been extensively studied but has not shown significant benefits in terms of survival or functional outcomes.

Conclusion

Acute ischaemic stroke presents a complex interplay of pathophysiological mechanisms, complications, and treatment challenges. Early intervention with reperfusion therapies remains critical, while understanding the roles of infection, inflammation, and systemic complications can guide comprehensive management strategies. Emerging treatments like hypothermia and ongoing research into glucose management and immune modulation hold promise for improving outcomes in AIS patients.