الفهرس 
PATHOPHYSIOLOGY OF STROKEOnly 14 pages are availabe for public view
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Abstract
S
troke is currently the second leading cause of death in the Western world, ranking after heart diseases and before caner and the most common reason for permanent disability.
Patients presenting in the early hours of stroke onset constitute a category of stroke patient known as the ”hyperacute stroke patient.” Dynamic advances in acute ischemic stroke treatment have changed the nihilistic approach of the past to one of energetic resolve. Following approval of recombinant tissue plasminogen activator by the Food and Drug Administration in 1996 for the treatment of hyperacute ischemic stroke, hyperacute stroke patient had a chance to receive a drug that might stop or reverse the evolution of ischemic stroke.
With the advent of thrombolytic therapy for acute stroke a variety of imaging techniques have revolutionized the physiologic understanding of cerebral ischemia. Computerized tomography and magnetic resonance imaging can provide important data on the pathophysiology of cerebral ischemia as well as structural and functional information on potentially salvageable tissue.
Thrombolytic therapy has revolutionized acute ischemic stroke treatment; however it is clear that intravenous thrombolytic therapy has certain limitations, including a short-time window for use, poor specificity for the site of arterial occlusion, and suboptimal recanalization rates. Some of these problems may be circumvented by using intra-arterial thrombolysis.
Several emerging strategies have the potential to extend cerebral reperfusion therapy to larger numbers of patients, including patients presenting beyond the current 3-hour time window.
Interventional neuroradiologists have made advances in the use of technologies, such as intra-arterial thrombolysis, stenting, and mechanical retrieval devices, which have provided teams with a number of interventions to optimize outcomes in stroke.
Intra-arterial therapy has been shown to be efficacious in opening occluded arteries in some patients with severe ischemic stroke. It allows more complete recanalization with lower total doses of thrombolytic. With the smaller dose, complications from systemic fibrinolytic effects, including intracranial hemorrhage, can be reduced.
To optimize patient outcomes, practitioners in acute care hospitals must have an organized approach to hyperacute stroke care. It requires interdisciplinary collaboration and protocols to rapidly assess, diagnose, treat, and evaluate stroke care.
Several new neuroprotective agents are currently emerging, based on recent advances in our understanding of molecular pathways that could be considered as potential therapeutic targets. However the results of trials in human are still disappointing.