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Ischemic cascade

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The ischemic cascade is a series of biochemical reactions that take place in the brain after seconds to minutes of ischemia (inadequate blood supply) (Arnold, 2003). Most ischemic neurons that die do so due to the activation of chemicals produced during and after ischemia (Internet Stroke Center, 2003). The ischemic cascade usually goes on for two to three hours but can last for days, even after normal blood flow returns (NINDS, 1999; Panacea Pharmaceuticals, 2004).

A cascade is a series of events in which one event triggers the next, in a linear fashion. Thus "ischemic cascade" is actually a misnomer, since in it, events are not always linear: in some cases, they are circular, and sometimes one event can cause or be caused by multiple other events (Hinkle and Bowman, 2003). In addition, cells receiving different amounts of blood may go through different chemical processes. Despite these facts, the ischemic cascade can be generally characterized as follows:

The fact that the ischemic cascade involves a number of steps has led doctors to suspect that neuroprotectants such as calcium channel blockers could be produced to interrupt the cascade at a single one of the steps, blocking the downstream effects. Though initial trials for such neuroprotective drugs led many to be hopeful, human clinical trials with neuroprotectants were unsuccessful and had to be cancelled.

References Edit

  • National Institute of Neurological Disorders and Stroke (NINDS). 1999. Stroke: Hope Through Research. Bethesda, Maryland: National Institutes of Health.
  • Panacea Pharmaceuticals. 2004. "Panacea Pharmaceuticals, Inc. Awarded SBIR from National Institute of Neurological Disorders and Stroke to Develop Neuroprotectants for Stroke and other Ischemia-Related Conditions."
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