Pharmacologic Therapy for Ischemic Cerebrovascular Disease.

摘要

Brain function depends on a steady and well-regulated supply of oxygenated blood. This absolute dependence is emphasized by the high incidence of mortality and morbidity associated with disorders of the cerebral circulation. In years past, no one dared hoped that neurons could survive more than a few minutes of ischemia, and all considered stroke untreatable. Experiments in the early 1970s, however, demonstrated that limited functional recovery occurred after 1 hour of complete ischemia. Moreover, it became clear that the periphery of an ischemic zone contained neurons that received enough blood supply to remain viable, but not enough to achieve normal synaptic function. The viable cells in this 'ischemic penumbra' could not be differentiated from cells already dead by neurologic examination or by electrical measures of brain function. The clinician, faced with an apparently devastated, hemiplegic, perhaps aphasic stroke victim, but awary that neurons might still survive within the ischemic area, could now begin to justify aggressive measures to restore flow and preserve or even improve functional recovery. Researchers have now described a plethora of pharmacologic agents and therapeutic maneuvers that improve blood flow or restore some function in a multitude of experimental models of stroke. Unfortunately, no one has yet demonstrated that any of these experimental approaches is unequivocally effective. Keywords: Hypertension, Antihypertensive drugs, Anticoagulants, Reprints. (KT)