Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, June 28, 2015

From Time is brain to Physiology is brain: a case for reflection in acute stroke treatment decisions

I'm sure your doctor subscribes to this and already has changed your stroke protocols because of this.
It's only 5 days old.
http://brain.oxfordjournals.org/content/138/7/1768

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DOI: http://dx.doi.org/10.1093/brain/awv120 1768-1770 First published online: 23 June 2015

This scientific commentary refers to ‘Perfusion computed tomography to assist decision making for stroke thrombolysis’, by Bivard et al. (doi:10.1093/brain/awv071).
The ischaemic penumbra, defined as severely hypoperfused, functionally impaired yet salvageable tissue, has been established as the key target for acute stroke therapy for more than three decades (Muir et al., 2006). However, the penumbra has a limited lifespan and, unless reperfused early, it progresses to become part of the irreversibly damaged tissue referred to as the ‘core’. The core therefore grows over time, incorporating first the most hypoperfused portions of the penumbra, and then progressively less hypoperfused portions, until none remains. How fast this process occurs varies greatly from subject to subject, mainly because of variable pial collaterals and the occurrence of spontaneous reperfusion (Fig. 1). On a mechanistic basis, reperfusion therapy—such as with intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA)—would be expected to be of no benefit, and potentially harmful, in cases with large core or no penumbra (Marchal et al., 1993).
Figure 1
The three main pathophysiological profiles used by Bivard et al. to categorize acute stroke patients, as originally defined using PET with 15oxygen-labelled compounds to generate quantitative maps of cerebral blood flow (CBF, left column) and the cerebral oxygen metabolic rate (CMRO2, right). Validated tissue compartments including penumbra (reduced cerebral blood flow but relatively preserved CMRO2) and core (markedly reduced CMRO2) were used to characterize the three profiles of ‘target mismatch', ‘large core' and ‘no mismatch' (Muir et al., 2006). Consistent with the strikingly distinct spontaneous outcomes associated with these profiles (Marchal et al., 1993), Bivard et al. provide evidence from their cohort that the target mismatch group, i.e. patients with significant penumbral tissue and a small core, benefit the most from intravenous …

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