...Stephen M. Davis; Geoffrey A. Donnan The concept of the ischemic penumbra was defined over 40 years ago by Lindsay Symon and his group and is now an established principle of all acute ischemic stroke therapies. These reperfusion treatments rescue threatened, critically hypoperfused brain tissue...

... management. The more sophisticated imaging-based selection, those assessing collateral blood flow or ischaemic penumbra appear to be associated with better outcomes and possibly fewer complications. The importance of achieving effective, quality reperfusion is also demonstrated, in a remarkably linear...

...Wolf-Dieter Heiss Background: Malignant middle cerebral artery infarction is a devastating condition, with up to 80% mortality in conservatively treated patients. The pathophysiology of this stroke is characterized by a large core of severe ischemia and only a relatively small rim of penumbra. Due...

... imaging Susceptibility-weighted imaging Oxygen extraction fraction DWI/PWI mismatch Penumbra Collaterals The susceptibility-weighted imaging (SWI) technique is a high spatial resolution accelerated 3D T2*-weighted gradient-echo sequence with the advantage of depicting and enhancing magnetic...

...Stephen Davis; Geoffrey A. Donnan The foundation of modern therapy for ischaemic stroke involves reperfusion of the ischaemic penumbra and salvage of threatened but potentially viable brain tissue. Work on imaging of the penumbra and clinical trials using penumbral evaluation or selection have been...

...Wolf-Dieter Heiss The concept of the ischemic penumbra was formulated 30 years ago based on experiments in animal models showing functional impairment and electrophysiological disturbances with decreasing flow to the brain below defined values (the threshold for function) and irreversible tissue...

...J.-C. Baron After middle cerebral artery occlusion (MCAO) in the laboratory animal, the ischemic penumbra has been documented as a severely hypoperfused, functionally impaired, but still viable cortex which can regain its function and escape infarction if it is reperfused before a certain time has...

...Mar Castellanos; Tomás Sobrino; José Castillo Ischemic penumbra defines the existence of tissue at risk of infarction and which is, hence, potentially salvageable and the target for current stroke reperfusion and neuroprotective therapies. Penumbral tissue evolves toward irreversibly damaged tissue...

... of this ischemic penumbra in the acute stroke clinical setting is an important goal for stroke researchers and clinicians. Recent advances in neuroimaging allowed a better understanding of this physiopathological process. However, there is not a perfect penumbra imaging technique and each one has its own...

... perfusion. Note however that the CMRO 2 further defines two distinct areas within cortical misery perfusion: posteriorly, the CMRO 2 is well preserved (red arrows), i.e. the tissue is viable, which could represent penumbra or oligemia or both; anteriorly, however, the CMRO 2 is close to zero (yellow...

... patients, quantitative mapping of CBF to indicate the severity and potential reversibility of neuronal damage can be used to predict which brain tissue will be salvaged with reperfusion or die without it (penumbra), as well as which brain tissue is already infarcted. Recent investigations of perfusion CT...

...Stephen M. Davis; Geoffrey A. Donnan The concept of the ischaemic penumbra as critically hypoperfused and functionally impaired, but potentially viable brain, was introduced over 25 years ago. Recent studies have used a combination of perfusion-weighted magnetic resonance imaging (PWI...

...Marc Fisher The concept of the ischemic penumbra is an important one for both basic investigators of cerebral ischemia and for clinicians who treat stroke patients. The ischemic penumbra has been defined in a variety of ways, but the most clinically relevant definition is that portion...

.... Diffusion-weighted imaging Magnetic resonance imaging Perfusion-weighted imaging Penumbra Stroke, acute Combined diffusion- and perfusion-weighted MRI (DWI and PWI) has recently become a strong diagnostic tool in the early assessment of cerebral ischemia in animals as well as humans [ 1, 2, 3...

.... Focal ischemia Penumbra Early damage Neuronal integrity Multitracer PET Animal model Ischemic stroke Reperfusion Thrombolytic therapy Reopening of the MCA induced immediate reperfusion of the previously ischemic territory, with flow values far above control in most instances. In 6 cats, CBF...

...Jean-Claude Baron The ischaemic penumbra has been documented in the laboratory animal as a severely hypoperfused, non-functional, but still viable cortex surrounding the irreversibly damaged ischaemic core; with elapsing time, more penumbra gets recruited into the core, while tissue reperfusion...

... operationally defined thresholds for tissue viability and the penumbra, and co-registering these tissue compartments to infarcted and non-infarcted tissue on late magnetic resonance imaging, the proportions of at-risk tissue salvaged from infarction could be revealed in individual patients. In the future...

... not prevent selective neuronal death, probably influenced by excitatory neurotransmitters. On the basis of animal studies, it is argued that several hours of ‘ischemic penumbra’ will eventually increase the neuronal loss even with a restoration of electrical activity. We studied acute-stroke cases (blood...