Chronic ischemic stroke
Vagal AS, Leach JL, Fernandez-Ulloa M, et al. The acetazolamide challenge: techniques and applications in the evaluation of chronic cerebral ischemia. AJNR Am J Neuroradiol. 2009; 30:876–884
cerebral hyperperfusion syndrome (AKA normal pressure hyperperfusion breakthrough): classically thought to result from return of blood flow to an area that has lost autoregulation due to chronic cerebral ischemia typically from high-grade stenosis.
Differentiating between acute and chronic infarction on a CT brain is an important skill for many health professionals particularly in the emergency setting.
pathology acute: cytotoxic oedema chronic: encephalomalacia hypoattuation acute: more dense than CSF chronic: CSF density mass effect acute: positive (volume gain) sulcal / ventricular effacement midline shift / herniation chronic: negative (volume loss) widened sulci exvaccuo dilatation of ipsilateral ventricle
In the chronic stage of stroke, functional recovery reaches a maximum by about 3–6 months, and there is no effective treatment to reduce stroke-related disability beyond this time except for rehabilitation therapy 1).
Autologous bone marrow derived mononuclear stem cells are safe and feasible in chronic ischemic stroke. Cell therapy with physiotherapy regime led to a trend of improvement in clinical and fMRI scores at 8 weeks as compared to physiotherapy alone and the changes lasted till 24 weeks. Stem cells are proposed to act as ‘Trojan horses’ in the at-risk nervous tissue by stimulation of repair mechanisms leading to behavioral recovery after stroke 2).
Treatment
Case series
50 patients suffering from completed ischemic stroke in the carotid territory for at least two months (17 mild, 31 moderate, 2 severe strokes) underwent extra-intracranial arterial bypass surgery. Neurological improvement was obtained in 43 cases; it persisted in time in 40 cases. Quantitative evaluation of motor performance in 21 patients showed that the degree of improvement was highly significant. Several factors strongly indicate a causal relation between surgical revascularization and neurological restoration. The positive surgical result is strictly dependent on correct patient selection and, in particular: i) on the documentation of local hemodynamic insufficiency; ii) on the occurrence of transient neurological (and to a certain extent EEG) improvement following hyperbaric oxygenation. The latter can also provide reliable information on the minimum degree of improvement to be expected from surgery 3).
Needs Classification
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41: Vakhnina NN, Zakharov VV. Narusheniia pokhodki i postural'noĭ ustoĭchivosti pri distsirkuliatornoĭ éntsefalopatii [Disturbances of gait and postural stability in chronic cerebral ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(1):78-84. Russian. doi: 10.17116/jnevro20171171178-84. PMID: 28635875.
42: Avrov MV. Kachestvo zhizni patsientov s khronicheskoĭ ishemieĭ golovnogo mozga [Quality of life of patients with chronic cerebral ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(4):56-58. Russian. doi: 10.17116/jnevro20171174156-58. PMID: 28617380.
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60: Vorob'eva OV, Rusaya VV. Farmakoterapiya trevozhnykh rasstroistv u patsientov s khronicheskoi ishemiei golovnogo mozga [Pharmacotherapy of anxiety disorders in patients with chronic cerebral ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova. 2016;116(12. Vyp. 2):49-55. Russian. doi: 10.17116/jnevro201611612249-54. PMID: 28300804.
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145: Fedin AI, Krasnoperov EN, Podobedova NS. Effektivnost' koaksila pri depressii u bol'nykh s khronicheskoĭ ishemieĭ golovnogo mozga [Coaxil efficacy in depression in patients with chronic cerebral ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova. 2004;104(10):67-8. Russian. PMID: 15553381.
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