Baillière's clinical neurology
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Interventional neuroradiology is a dynamic subspecialty which is rapidly gaining new applications in the treatment of neurological diseases. The most common therapeutic role is still in the treatment of brain AVMs, aneurysms and fistulae in close association with neurosurgical support. Endovascular treatment of aneurysms with thrombogenic coils is a promising technique which can be performed with low morbidity. ⋯ Angioplasty and papaverine infusion for treatment of cerebral vasospasm are being performed in most neurosurgical teaching centres. Although angiographic results are often impressive, corresponding clinical improvement is not always seen, particularly when treatment is delayed. Thrombolysis for treatment of acute stroke and angioplasty for treatment of cerebrovascular atherosclerosis are new techniques which await scientific validation before being accepted as standard therapies.
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Baillieres Clin Neurol · Aug 1995
ReviewThe penumbra, therapeutic time window and acute ischaemic stroke.
There is a great deal of evidence that an ischaemic penumbra exists in animals and humans after the occurrence of focal brain ischaemia (Hossmann, 1994). The concept of the penumbra leads to the idea of a therapeutic time window. Because, if the region of irreversible injury (infarction) after focal ischaemia evolves in time and space, then the possibility of therapy to interfere becomes a tenable hypothesis. ⋯ The new MRI techniques might afford this possibility. As we enter the exciting era of effective therapy for acute ischaemic stroke, the issues surrounding the therapeutic time window(shade) will become more critical, because it is this critical time that will define the success or failure of our interventions. Therefore it is incumbent upon basic stroke researchers and clinicians to continue to define the ischaemic penumbra and to develop readily applicable mechanisms to identify and treat this moving target.