title: Brain attack: needing resuscitation.
abstract: The brain is extremely susceptible to focal ischaemia. Following vascular occlusion, a core of severely damaged brain tissue develops, surrounded by an ischaemic penumbra. This potentially-salvageable penumbra may be estimated by advanced neuroimaging techniques, particularly by diffusion-perfusion mismatch. Clinical trials have demonstrated the efficacy of intravenous thrombolysis within three hours of onset of ischaemic stroke in reducing short-term disability. Recanalisation is enhanced by intra-arterial thrombolysis, sonothrombolysis and clot-retrieval devices. Occasionally, reperfusion injury may lead to clinical deterioration. The search continues for effective neuroprotectants. Brain perfusion needs to be maintained through blood and intracranial pressure management. Hemicraniectomy for 'malignant' cerebral oedema reduces death and disability. Elevated glucose should be controlled and hypoxia alleviated. Public education of symptoms and the need for immediate presentation to a medical facility is needed. Stroke unit care reduces death and disability with little increase in cost. Current evidence supports urgent efforts to resuscitate the brain after stroke.
authors: Division of Neurology, University Medicine Cluster, National University Health Systems, 5 Lower Kent Ridge Road, Singapore 119074. ramani_nv@nuhs.edu.sg
authors: N
authors: N
authors: Venketasubramanian
authors: B P L
authors: BP
authors: Chan
authors: H M
authors: HM
authors: Chang
authors: H C
authors: HC
authors: Chua
authors: R N
authors: RN
authors: Gan
authors: F
authors: F
authors: Hui
authors: W
authors: W
authors: Lee
authors: I
authors: I
authors: Ng
authors: V K
authors: VK
authors: Sharma
authors: R
authors: R
authors: Singh
authors: H L
authors: HL
authors: Teoh
authors: E
authors: E
authors: Wang
authors: C L H
authors: CL
authors: Chen
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D008991:Monitoring, Physiologic; D012151:Resuscitation; D012846:Singapore; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy