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Cerebral infarction basically comprises two pathophysiologic processes one, a loss in the supply of oxygen and glucose secondary to vascular occlusion, and the other, an array of changes in cellular metabolism consequent to the collapse of energy-producing processes, ultimately with disintegration of cell membranes Of potential therapeutic importance are the observations that some of the cellular processes leading to neuronal death are not irrevocable and may be reversed by early intervention, either through restoration of blood ow, by prevention of the in ux of calcium into cells, or by interdicting intermediary processes involved in cell death Vascular Factors At the center of an ischemic stroke is a zone of infarction The necrotic tissue swells rapidly, mainly because of excessive intracellular and intercellular water content Since anoxia also causes necrosis and swelling of cerebral tissue (although in a different distribution), oxygen lack must be a factor common to both infarction and anoxic encephalopathy The effects of ischemia, whether functional and reversible or structural and irreversible, depend on its degree and duration The margins of the infarct are hyperemic, being nourished by meningeal collaterals, and here there is only minimal or no parenchymal damage If the brain is observed at the time of arterial occlusion, the venous blood is rst seen to darken, owing to an increase in reduced hemoglobin The viscosity of the blood and resistance to ow both increase, and there is sludging of formed elements within vessels The tissue becomes pale Arteries and arterioles become narrowed, especially in the pale areas Upon re-establishing ow in the occluded artery, the sequence is reversed and there may be a slight hyperemia If the ischemia is prolonged, sludging and endothelial damage prevent normal re ow (the no-re ow phenomenon described below) These ow factors have been studied in experimental animals by Heiss and by Siesjo and others and are reviewed in detail by Hossman These investigators have determined the critical threshold of cerebral blood ow (CBF), measured by xenon clearance, below which functional impairment occurs In several animal species, including macaque monkeys and gerbils, the critical level was 23 mL/100 g/min (normal is 55 mL); if, after short periods of time, CBF is restored to higher levels the impairment of function can be reversed Reduction of CBF below 10 to 12 mL/100 g/min causes infarction, almost regardless of its duration The critical level of hypoperfusion that abolishes function and leads to tissue damage is therefore a CBF between 12 and 23 mL/100 g/min At these levels of blood ow the EEG is slowed, and below this level it becomes isoelectric In the region of marginal perfusion ( ischemic penumbra ), the K level increases (ef ux from injured depolarized cells) and ATP and creatine phosphate are depleted These biochemical abnormalities are reversible if the circulation is restored to normal Disturbance of calcium ion homeostasis and accumulation of free fatty acids interfere with full recovery A CBF of 6 to 8 mL/100 g/min causes marked ATP depletion, increase in extracellular K, increase in intracellular Ca, and cellular acidosis,. java ean 13 generator Generate EAN - 13 barcode in Java class using Java ... - OnBarcode
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qr code generator vb.net free Java Barcode generates barcode EAN - 13 images in Java applications. asp.net barcode reader sdk Focal cerebral ischemia differs fundamentally from global ischemia In the latter state, if absolute, there is no cerebral blood ow of the entire brain and irreversible destruction of neurons occurs within 4 to 8 min at normal body temperature In focal ischemia, there is nearly always some degree of circulation (via collateral vessels), permitting to a varying extent the delivery of oxygenated blood and glucose The effects of a focal arterial occlusion on brain tissue also vary depending on the location of the occlusion in relation to available collateral and anastomotic channels If the obstruction lies proximal to the circle of Willis (toward the heart), the anterior and posterior communicating arteries of the circle are often adequate to prevent infarction In occlusion of the internal carotid artery in the neck, there may be anastomotic ow from the external carotid artery through the ophthalmic artery or via other smaller externalinternal connections (Fig 34-2) With blockage of the vertebral artery, the anastomotic ow may be via the deep cervical, thyrocervical, or occipital arteries or retrograde from the other vertebral artery If the occlusion is in the stem portion of one of the cerebral arteries, ie, distal to the circle of Willis, a series of meningeal interarterial anastomoses may carry suf cient blood into the compromised territory to lessen (rarely to prevent) ischemic damage (see Figs 34-2 and 34-3) There is also a capillary anastomotic system between adjacent arterial branches, and although it may reduce the size of the ischemic eld, particularly of the penetrating arteries, it is usually not signi cant in preventing infarction Thus, in the event of occlusion of a major arterial trunk, the extent of infarction ranges from none at all to the entire vascular territory of that vessel Between these two extremes are all degrees of variation in the extent of infarction and its degree of completeness Additional ischemia-modifying factors determine the extent of necrosis The speed of occlusion assumes importance; gradual narrowing of a vessel allows time for collateral channels to open The level of blood pressure may in uence the result; hypotension at a critical moment may render anastomotic channels ineffective Hypoxia and hypercapnia are presumed to have deleterious effects Altered viscosity and osmolality of the blood and hyperglycemia are potentially important factors but dif cult to evaluate Finally, anomalies of vascular arrangement (of neck vessels, circle of Willis, and surface arteries) and the existence of previous vascular occlusions must in uence the outcome The speci c neurologic de cit obviously relates to the location and size of the infarct or focus of ischemia The territory of any artery, large or small, deep or super cial, may be involved When an infarct lies in the territory of a carotid artery, as would be expected, unilateral signs predominate: hemiplegia, hemianesthesia, hemianopia, aphasia, and agnosias are the usual consequences In the territory of the basilar artery, the signs of infarction. ean 13 barcode generator javascript EAN - 13 Java Barcode Generator /Class - TarCode.com
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