Phenomena Associated With Focal Ischaemia in the Central Nervous System
Occlusive vascular disease is the occasion of focal brain ischaemia. Whatever the primary nature of the vascular obstruction, the effect is the same, blood supply to the area supplied by the vessel in question is reduced, and a number of pathophysiological phenomena are set in train both in the area of ischaemia and in the surrounding regions where an attempt is made to replace the lost blood flow from collateral vessels. It is an everyday clinical experience that a dense neurological deficit soon after a cerebral ischaemic episode may gradually resolve and finally even disappear. It seems likely that cells may survive in a state of structural integrity yet with paralysis of function. Possible explanations for subsequent recovery may either be improvement in the residual circulation with expansion of collateral vessels from neighbouring cerebro-vascular beds, or modification of the neuronal metabolism itself so that function may be resumed at a lower basal level of blood flow.
KeywordsMiddle Cerebral Artery Occlusion Collateral Vessel Focal Ischaemia Lower Basal Level Residual Circulation
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