Acute ischemic infarction
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Acute Ischemic Infarction: Key Insights from Recent Research
Hyperglycemia and Stroke Outcomes
Impact of Acute Blood Glucose Levels
Hyperglycemia during acute ischemic stroke has been shown to worsen clinical outcomes, particularly in nonlacunar strokes. Higher admission blood glucose levels are associated with poorer outcomes at three months, as indicated by a Glasgow Outcome Scale score and a modified Barthel index. However, this relationship is not observed in lacunar strokes, where the effect of glucose levels on outcomes varies depending on the treatment received.
Infarct Progression and Treatment
Infarct Progression in Endovascular Therapy
Infarct progression in acute ischemic stroke can vary significantly, even with successful early revascularization. Nearly half of the patients do not achieve functional independence post-recanalization due to extensive irreversible damage at the time of treatment. The progression of brain injury is influenced by the balance between brain energy consumption and collateral perfusion supply, highlighting the need for individualized therapeutic approaches to mitigate infarct progression.
Remote Ischemic Perconditioning
Remote ischemic perconditioning, a treatment involving cycles of blood pressure manipulation in the lower limb, has been investigated for its potential to reduce brain infarction volume growth. However, a recent clinical trial found no significant effect on infarction volume growth or 90-day mortality when compared to standard care alone. This suggests that while promising in animal models, remote ischemic perconditioning may not provide the same benefits in human patients with acute ischemic stroke.
Infarct Topology and Clinical Outcomes
Lesion Volume and Symptom Severity
The location and volume of ischemic infarcts significantly influence stroke severity and outcomes. Infarcts in regions such as the bilateral lentiform nuclei, insular ribbons, and middle corona radiata are associated with larger volumes and more severe symptoms at both admission and discharge. Conversely, infarcts in the brain stem and thalami, despite being smaller, are linked to higher symptom severity relative to their volume.
Perfusion Computed Tomography (PCT)
PCT is a valuable tool for evaluating acute ischemic stroke, providing critical data on core infarction and penumbral tissue. This imaging technique helps identify regions of the brain that are ischemic but still viable, guiding reperfusion therapy to preserve at-risk tissue. PCT-derived perfusion maps, including cerebral blood flow and volume, are essential for determining the extent of core infarction and penumbra.
Functional Outcomes and Follow-Up Infarct Volume
Predictive Value of Follow-Up Infarct Volume
Follow-up infarct volume (FIV) is a strong predictor of functional outcomes in acute ischemic stroke. Larger FIVs are associated with worse outcomes, and this relationship holds true regardless of the imaging modality (CT or MRI) or the timing of the assessment. FIV measured within 48 hours post-stroke is particularly indicative of long-term functional outcomes, emphasizing the importance of early and accurate imaging.
Concurrent Acute Ischemic Stroke and Myocardial Infarction
Challenges in Management
The co-occurrence of acute ischemic stroke (AIS) and acute myocardial infarction (AMI) presents significant treatment challenges. Both conditions require time-sensitive interventions, and the presence of one increases the risk of the other . Effective management involves careful evaluation and potentially aggressive treatment strategies to mitigate the risks associated with these concurrent events .
Conclusion
Recent research underscores the complexity of acute ischemic stroke management, highlighting the critical roles of hyperglycemia control, timely and precise imaging, and individualized treatment strategies. Understanding the interplay between infarct volume, location, and progression is essential for improving patient outcomes. Additionally, the concurrent occurrence of AIS and AMI necessitates a nuanced approach to treatment, balancing the needs of both conditions to optimize recovery.
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