The Ischemic Penumbra presents the current status of concepts and research on this topic and identifies the latest methods for clinicians to quickly and efficiently recognize viable cerebral tissue for enhanced stroke management. Focusing on state-of-the-science technologies and current trends, the book examines imaging strategies utilizing PET, SPECT, MR, and CT for improved identification of key areas for intervention and therapy in the management of stroke patients.
With chapters by international authorities on the topic—including the originator of the ischemic penumbra concept, Professor Lindsay Symon—this volume provides a comprehensive view of the ischemic penumbra ranging from neurochemical processes to clinical implications, imaging, and therapy. It contains the first authoritative discussion of the thresholds and duration of the ischemic penumbra documented in various species, with sections that outline cerebral blood flow levels and their effects on important biochemical parameters. The book also supplies an authoritative series of chapters individually focused on current imaging techniques to target the location and extent of the penumbra. It outlines the relevance of the ischemic penumbra to specific therapies, such as extending time windows for therapy, and studies the determination of the presence of penumbra using a novel imaging/clinical mismatch concept, with clinical evidence and validation to date.
Table of Contents
THE ISCHAEMIC PENUMBRA: AN OVERVIEW. The Ischaemic Penumbra: The Beginning. The Ischaemic Penumbra: Overview, Definition, and Criteria. Perfusion Thresholds in Cerebral Ischaemia. Duration and Thresholds of the Ischemic Penumbra in Different Species. The Ischaemic Cascade: Events Within the Penumbra. Multimodal Mapping of the Ischaemic Penumbra in Animal Models. Molecular Biology of the Penumbra.Selective Neuronal Loss. Inflammation and Reperfusion Injury Within the Penumbra. IMAGING THE PENUMBRA: OTHER APPROACHES. Imaging the Penumbra with PET Flumazenil. Imaging the Penumbra: PET FMISO. Can the Penumbra be Imaged Using SPECT? Imaging the Penumbra with MR in Animals. Penumbra Imaged with MRI in Humans. Imaging the Penumbra with CT. MR Imaging the Ischemic Penumbra: New Techniques. Clinical / Imaging Mismatch. The Topography of the Ischaemic Penumbra. The Penumbra and Intracerebral Hemorrhage. THE ISCHAEMIC PENUMBRA: IMPLICATIONS FOR THERAPY. Extending the Time Window for Therapy. MR in the Selection for Stroke Therapies