The acute ischemic penumbra: Topography, life span, and therapeutic response

Myron D. Ginsberg, L. Belayev, W. Zhao, P. W. Huh, R. Busto

Research output: Contribution to journalReview article

23 Scopus citations

Abstract

Recent advances in computerized image-averaging, used in conjunction with refined techniques for engendering highly reproducible rodent models of focal ischemia, now make it possible to derive topographically precise, quantitative descriptors of the ischemic penumbra its localization, lifespan, metabolic and hemodynamic features, and responses to therapy. Physiologically monitored normothermic rats received 2-h middle cerebral artery occlusion (MCAo) by means of a poly-L-lysine-coated intraluminal suture. In matched groups, local cerebral blood flow (LCBF) or glucose utilization (LCMRglc) were measured autoradiographically at either 2-h MCAo or at 1-h recirculation and were correlated on a pixel-by-pixel basis with histopathological infarction after 3-day survival. A large, consistent ischemic penumbra (defined as LCBF 20 40% of control) surrounded the core (0.20% of control). Penumbral LCMRglc at 2-h MCAo was near-normal, and its metabolism/flow ratio was elevated 4-fold above normal. By 1-h recirculation, however, LCMRglc throughout the prior zone of ischemia was depressed. Infarctive histopathology was precisely determined by the antecedent LCBF decrement during ischemia: 70% and 89% of infarcted pixels had antecedent LCBF values below the upper-core and upper-penumbral ranges, respectively, at 2-h MCAo. High-dose albumin therapy at the onset of recirculation dramatically attenuated cortical infarction and brain edema and appeared, by LCBF analysis at 1-h recirculation, to increase postischemic LCBF primarily in the former penumbra.

Original languageEnglish (US)
Pages (from-to)45-50
Number of pages6
JournalActa Neurochirurgica, Supplement
Volume1999
Issue numberSUPPL. 73
DOIs
StatePublished - Jan 1 1999

Keywords

  • Cerebral blood flow
  • Focal ischemia
  • Image-processing
  • Metabolism

ASJC Scopus subject areas

  • Medicine(all)
  • Clinical Neurology

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