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STROKE
1=Ischemic cascade
Gene
Regulation of injury
APOPTOSIS
(CASPASE)
3=cascade of apoptotic events
ISCHEMIA
(necrotic
cell death)
(apoptosis :programmed
cell death) Caspase
(caspase apoptosis: programmed cell dea
(necrosis)
CALCIUM HOMEOSTASIS
1. ATP-ase dependent membrane Ca++out; Na+ in/out; K+
in.
2. Glutamate in Ca++ in via NMDA.
3
1 2
VSCC VSCC
3
3
4
4
6
5
peroxynitrite
VASODILATATION CYTOTOXIC
cNOS = constitutive nitric oxide synthase iNOS = inducible nitric oxide synthase
NO = nitric oxide * inhibitors of NO synthase
GTP = guanosine triphosphate LNMMA = NG-monomethyl L-arginine
cGMP= cyclic guanosine monophosphate L-NNA = NG-nitro L-arginine
L-NAME = NG-nitroL-arginine-methyl ester
STROKE
(migration)
(adhesion)
1
2
4
3 6
(TGF = transforming growth factor)
5
7
(ADHESION-STRENG-
THENING STAGE)
(SELECTIN-MEDIATED
ROLLING) (CRAWLING OF THE
GRANULOCYTE
LEUCOCYTE-ENDOTHELIUM INTERACTION
Vascular Response to Inflammation
Decreased blood flow allows
leukocytes to interact with
endothelium
rolling adhesion (weak) initiated via
interactions between carbohydrate
moieties and Selectins (stage I)
allows for strong interaction
between LFAs (leucocyte factor of
adhesion) and ICAMs (stage II) (Stage I)
(Stage II)
(Stage III)
rolling arrested and extravasation
begins (stage III)
MMPs (metalloproteinase) are
secreted to facilitate transversion of
the basement membrane
CASCADE OF APOPTOTIC EVENTS IN ISCHEMIA
(SCHULTZ 1999)
Lacunar
SMALL VESSEL DISEASE
Result from:
Characterized by:
A thickening of the basement membrane
Proliferation of the endothelium
The development of microatheroma with a high content
of foam cells
The lacunar hypothesis proposes that (1) symptomatic lacunes
present with distinctive lacunar syndromes and (2) a lacune is due to
occlusion of a single deep penetrating artery generated by a specific
vascular pathology.
Ataxic hemiparesis
This is the second most frequent lacunar syndrome, consisting of
weakness and clumsiness on one side of the body.
The most frequent sites of infarction are the posterior limb of
the internal capsule, basis pontis, and corona radiata.