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By Werner Hacke MD, Herman J. Gelmers MD, Michael Hennerici MD, Günter Krämer MD (auth.)

Despite a global aid in its occurrence, stroke continues to be essentially the most universal ailments typically and an important reason behind untimely and chronic incapacity within the industrialized nations. the main common explanation for stroke is a localized disturbance of cerebral flow, i.e., cerebral ischemia. much less universal are spon­ taneous intracerebral and subarachnoid hemorrhages and sinus ve­ nous thromboses. The advent of recent diagnostic techniques reminiscent of cranial computed tomography, magnetic resonance imaging, digi­ tal subtraction radiologic innovations, and numerous ultrasound tech­ niques has resulted in awesome advances within the prognosis of stroke. in the course of the deliberate program of those options, it really is even attainable to spot the pathogenetic mechanisms underlying focal cerebral ischemia in people. even though, those diagnostic advances have made the space among diagnostic accuracy and healing implications even more than prior to. This truth might be simply defined. long ago, healing experiences needed to be in keeping with the indicators and temporal features of stroke; it was once most unlikely for early investigations to think about many of the pathogeneses of cerebral ischemia. necessarily, stroke sufferers have been handled as being affected by a uniform disease.

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Summary diagram of regulation of cerebral circulation this is regional or focal ischemia, in which only particular regions of the brain become ischemic. This is caused by a series of different pathogenetic mechanisms (see Chap. 4). 1 Ischemic Thresholds and the Penumbra Whatever the causes of local or global ischemia may be, they eventually lead to a focal or general reduction of perfusion in the central nervous system and hence to a reduced supply of O 2 and glucose. As has already been noted in connection with brain cell metabolism, and in contrast to other cells, the activity of brain cells is very rapidly impaired by disturbed energy supply.

70 60 " 50 40 r 1900 1920 1940 1960 1980 Year Fig. 1. Annual mortality (per 100000) for cardiovascular and cerebrovascular diseases. 4. Incidence figures for cerebrovascular diseases. (From Matsumoto et al. 1973; Garraway et al. 1979) 1955-1969 Under 45 years 45-54 years 55-64 years 65-74 years Over 75 years Total 1970-1974 Men Women Men Women 43 160 510 1080 2500 35 70 260 600 1900 21 100 300 720 3350 30 60 190 520 2760 214 136 153 119 When interpreting prevalence figures for the various types of cerebrovascular disease, it is of the greatest importance to consider the source of the data.

Here, only the concept of RIND is used, and the emphasis is on regression within about 3 days. Sometimes, however, one speaks of prolonged reversible ischemic neurologic deficit (PRIND), in which regression is possible up to the 7th day. In contrast to a widely held opinion, a rapid clinical improvement with an only mildly persistent or fluctuating functional disturbance after an infarct does not justify a waitand-see attitude. Rather, such transient ischemias should result in a prophylactic search for a treatable cause.

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