[Advances in the diagnosis and treatment of cerebral ischemia during the acute phase].
Recent advances in MRI technology and the development of effective neuroprotective agents has improved the outcome of stroke. In order to salvage tissue after an ischemic insult it is important to differentiate the core and penumbra area of the ischemic lesion. The penumbra surrounds the ischemic core, damage in this area is reversible if effective neuroprotective agents are given and reperfusion occurs. In this symposium detection of penumbra in an ischemic lesion using diffusion weighted imaging (DWI) and perfusion imaging (PI), diffusion-perfusion mismatch, and indications for thrombolytic therapy are discussed. If a hypoperfusion area is revealed with PI without a corresponding lesion indicated with DWI or when the DWI lesion is less than one third of the PI lesion, combined thrombolytic and neuroprotective therapies are recommended. In contrast, when both PI and DWI show an identical lesion, only neuroprotective therapy is advised. Additionally, newly developed neuroprotective agents, especially the combined effect of rt-PA and the immunosuppressant, FK506, on an embolic infarct model are discussed.
Katayama
Yasuo
Y
Second Department of Internal Medicine, Nippon Medical School.
Igarashi
Hironaka
H
D000210:Acute-Phase Reaction / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D000983:Antipyrine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D015195:Drug Design; D004359:Drug Therapy, Combination; D000077553:Edaravone; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009414:Nerve Growth Factors / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D009414:Nerve Growth Factors; D018696:Neuroprotective Agents; D011994:Recombinant Proteins; D009536:Niacinamide; D010959:Tissue Plasminogen Activator; D000077553:Edaravone; D000983:Antipyrine; C042625:nicaraven; D016559:Tacrolimus