Endogenous neuoprotection is a phenomenon where a brief episode of ischemia renders the brain resistant against a subsequent longer-asting ischemia event. Experimentally, the author was able to model hypoxic preconditioning in animal model. Increasing knowledge of this endogenous neuroprotectin by ischemic tolerance may help to minimize neuronal damage following ischemic stroke and hypoxic encephalopathy. This book is, therefore, the first overview of this important topic and will certainly influence further investigations in clinical and neuroscience research.
This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.
Given the very limited capacity of regeneration in the brain, protecting neurons that are on the brink of death is a major challenge for basic and clinical neuroscience, with implications for a broad spectrum of acute and chronic neurological and psychiatric diseases. This book brings together leading experts from neurobiology, neurophysiology, neuropharmacology, neuroimmunology and clinical neuroscience to highlight the most recent milestones in this rapidly evolving field. The book will serve as a reference for both basic neuroscientists and clinicians interested in an authoritative update on the molecular and cellular biology of neuroprotection and its promises for new therapeutic strategies.
A distinction between primary and secondary brain damage of vari ous origin, particularly in acute lesions, such as head injury and ische mia is not entirely new. The concept is of practical significance, be cause it is the foremost intention of all clinical efforts to prevent, or at least attenuate the development of secondary sequelae. Primary dam age to nervous elements usually cannot be influenced by treatment. Its prevention is the objective of prophylactic measures. The current volume gathered prominent scientists and clinicians from various fields to pro vide a competent introduction and survey of the various aspects involved in secondary brain damage. It was attempted to provide criteria for the distinction between the primary and secondary phenomena on a morpho logical and functional level, on the basis of the kinetics involved and, most importantly, regarding the different specific manifestations, such as disturbances of microcirculation, aspects of the blood-brain barrier, and of cellular structure and function at a molecular level. Although it was not expected that a grand unifying hypothesis will be reached recon cilable with the many, occasionally opposing views on such a complex subject, nevertheless, the present volume attains an appropriate result. It can best be described as a mosaic of many different pieces which only as an ensemble reflect the current state of the art.
This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.
Toole's Cerebrovascular Disorders was the first modern book devoted to care of the stroke, originally published more than 40 years ago. This is a completely revised and updated sixth edition of the highly respected standard for stroke diagnosis and treatment. Dr James Toole has stayed on as a consultant for the text, and Drs E. Steve Roach, Kerstin Bettermann, and Jose Biller have reworked Dr Toole's book to include chapters on genetics, pregnancy-related stroke, and acute treatments. The practical focus of the book has not changed, retaining its emphasis on bedside diagnosis and treatment. Easily accessible both for stroke specialists and residents, the sixth edition has been modernized to keep pace with the rapid expansion of knowledge in stroke care and includes evidence-based recommendations, the latest technology and imaging, and risk factors. The text is supplemented with more than 200 images, many in color.
Highlighting concepts of brain ischemia, this book looks at the molecular mechanisms of its development leading to brain tissue changes and describes strategies of neuroprotective therapy. Coverage includes cellular reactions in response to acute focal brain ischemia, microglial activation and local inflammation in focal brain ischemia, programmed cell death, primary and secondary neuroprotection, gangliosides, and modern therapeutic approaches to acute focal brain ischemia. The authors are neurologists affiliated with the Russian State Medical University. Annotation (c)2003 Book News, Inc., Portland, OR (booknews.com).
Handbook of Neuroemergency Clinical Trials, Second Edition, focuses on the practice of clinical trials in acute neuroscience populations, or what have been called neuroemergencies. Neuroemergencies are complex, life-threatening diseases and disorders, often with devastating consequences, including death or disability. The overall costs are staggering in terms of annual incidence and costs associated with treatment and survival, yet despite their significance as public health issues, there are few drugs and devices available for definitive treatment. The book focuses on novel therapies and the unique challenges their intended targets pose for the design and analysis of clinical trials. This volume provides neurologists, neuroscientists, and drug developers with a more complete understanding of the scientific and medical issues of relevance in designing and initiating clinical development plans for novel drugs intended for acute neuroscience populations. The editors provide the best understanding of the pitfalls associated with acute CNS drug development and the best information on how to approach and solve issues that have plagued drug development. - Presents a comprehensive overview on clinical trials and drug development challenges in acute neuroscience populations - Provides neurologists, neuroscientists and drug developers with a complete understanding of scientific and medical issues related to designing clinical trials - Edited by leaders in the field who have designed and managed over 50 neuroemergency clinical trials
