Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke

Now if we just had some stroke leadership that would take this and create a strategy with it to solve stroke. BUT NO, WE HAVE NOTHING IN STROKE, NO LEADERSHIP, NO STRATEGY,ABSOLUTELY  NOTHING!

 

Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke

Maria H.H. Balch1,2, Shahid M. Nimjee1, Cameron Rink1, Yousef Hannawi3

1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA 2Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA 3Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Correspondence  Yousef Hannawi ,Tel: +1-614-685-7234, Fax: +1-614-366-7004 , Email: yousefhannawi@yahoo.com

Received: November 2, 2019   Revised: January 28, 2020   Accepted: March 17, 2020   Published online: May 31, 2020

Abstract

Stroke research has traditionally focused on the cerebral processes following ischemic brain injury, where oxygen and glucose deprivation incite prolonged activation of excitatory neurotransmitter receptors, intracellular calcium accumulation, inflammation, reactive oxygen species proliferation, and ultimately neuronal death. A recent growing body of evidence, however, points to far-reaching pathophysiological consequences of acute ischemic stroke. Shortly after stroke onset, peripheral immunodepression in conjunction with hyperstimulation of autonomic and neuroendocrine pathways and motor pathway impairment result in dysfunction of the respiratory, urinary, cardiovascular, gastrointestinal, musculoskeletal, and endocrine systems. These end organ abnormalities play a major role in the morbidity and mortality of acute ischemic stroke. Using a pathophysiology-based approach, this current review discusses the pathophysiological mechanisms following ischemic brain insult that result in end organ dysfunction. By characterizing stroke as a systemic disease, future research must consider bidirectional interactions between the brain and peripheral organs to inform treatment paradigms and develop effective, comprehensive therapeutics for acute ischemic stroke.