Overview of Cerebral Ischemia: Rationale for Cerebral Protection

  • Robert F. Spetzler
  • Thomas W. Grahm
  • Daniel G. Nehls
Conference paper


With the onset of profound cerebral ischemia, a complex chain of events is set into motion. If there is no intervention, irreversible damage occurs within several minutes. Although the primary insult of cerebral ischemia is a reduction in the supply of major nutrients, the depletion of cellular energy stores soon triggers a series of secondary events known as the “ischemic cascade.” However, numerous factors influence the course of cerebral ischemia, and cell death is not necessarily the inevitable outcome. A simplified scheme of the progression of cerebral ischemia, with identification of possible sites for treatment, is presented in Figs. 1–3.


Cerebral Blood Flow Cerebral Ischemia Cerebral Edema Osmotic Dehydration Cereb Blood Flow 
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  1. 1.
    Ames A III, Wright RL, Kowada M, Thurston JM, Majno G (1968) Cerebral ischemia: II. The non-reflow phenomenon. Am J Pathol 52:437–453Google Scholar
  2. 2.
    Black KL, Hoff JT (1985) Leukotrienes increase blood-brain barrier permeability following intraparenchymal injections in rats. Ann Neurol 18(3):349–351PubMedCrossRefGoogle Scholar
  3. 3.
    Black KL, Hoff JT, McGillicuddy JE, et al. (1986) Increased leukotriene C4 and vasogenic edema surrounding brain tumors in humans. Ann Neurol 19(6):592–595PubMedCrossRefGoogle Scholar
  4. 4.
    Carter LP, Yamagata S, Erspamer R (1974) Time limits of reversible cortical ischemia. Neurosurgery 12:620–623CrossRefGoogle Scholar
  5. 5.
    Harris RJ, Lindquist C, Kamiya K, et al. (1983) The role of leukotrienes in the formation of cerebral ischemic edema. J Cereb Blood Flow Metab 3(1):S285–S286Google Scholar
  6. 6.
    Ibayashi S, Fujishima M, Sadoshima S, et al. (1986) Cerebral blood flow and tissue metabolism in experimental cerebral ischemia of spontaneously hypertensive rats with hyper-, normo-, and hypoglycemia. Stroke 17(2):261–266PubMedCrossRefGoogle Scholar
  7. 7.
    Jernigan J, Evans OB, Kirshner HS (1984) Hyperglycemia and diabetes improve outcome in a rat model of anoxia/ischemia. Neurology 34 (Suppl 1):262Google Scholar
  8. 8.
    Jones TH, Morawetz RB, Crowell RM, et al. (1981) Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54:773–782PubMedCrossRefGoogle Scholar
  9. 9.
    Klatzo I (1967) Neuropathological aspects of brain edema. Presidential address. J Neuropathol Exp Neurol 26:1–14CrossRefGoogle Scholar
  10. 10.
    Koide T, Wieloch TW, Seisjo BK (1986) Chronic dexamethasone pretreatment aggravates ischemic neuronal necrosis. J Cereb Blood Flow Metab 6:395–404PubMedCrossRefGoogle Scholar
  11. 11.
    Rehncrona S, Folbergrova J, Smith DS, et al. (1980) Influence of complete and pronounced incomplete cerebral ischemia and subsequent recirculation on cortical concentrations of oxidized and reduced glutathione in the rat. J Neurochem 34:477–486PubMedCrossRefGoogle Scholar
  12. 12.
    Rehncrona S, Westerberg B, Akesson B, et al. (1982) Brain cortical fatty acids and phospholipids during and following complete and severe incomplete ischemia. J Neurochem 38(1):84–93PubMedCrossRefGoogle Scholar
  13. 13.
    Shiu GK, Nemoto EM, Alexander HL (1981) Brain free fatty acid changes during global ischemia with barbiturate anesthesia and hypothermia (Abstract). Br J Anaesthesiol 53:304Google Scholar
  14. 14.
    Spetzler RF, Nehls DG (1987) Cerebral protection against ischemia, chap. VII-D. In: Wood JH (ed) Cerebral blood flow: Physiology and clinical aspects. McGraw-Hill, New YorkGoogle Scholar

Copyright information

© Springer Japan 1988

Authors and Affiliations

  • Robert F. Spetzler
    • 1
  • Thomas W. Grahm
    • 1
  • Daniel G. Nehls
    • 1
  1. 1.Barrow Neurological InstitutePhoenixUSA

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