Advances in Acute Ischemic Stroke

Dear Colleagues,

Ischemic stroke entails a set of rapidly developing clinical symptoms characterized by a sudden, focal or generalized brain disorder resulting from the dysfunction of brain circulation, lasting 24 hours or longer or leading to death. Ischemic stroke in adults and in pediatric patients is characterized by different pathophysiological mechanisms. Atherosclerosis plays the most important role in the cerebral stroke development in adults whereas thrombotic vascular occlusion in pediatric AIS is caused by endothelial and blood coagulation disorders that lead to procoagulant states. While AIS is most often provoked by both genetic and environmental risk factors, the role of exposure to external risk factors like lifestyle that play key roles in adults, appear to have less clinical importance in children. The interactions between existing factors of ischemic stroke are also significant from a pathophysiological point of view.

Symptoms of acute phase of stroke may differ between men and women; increased knowledge on this phenomenon may thus reduce the number of misdiagnoses or diagnostic delays, which in turn will affect the length of hospitalization and degree of post-stroke outcomes. For proper and efficient diagnosis in patients with acute neurological symptoms, the use of modern neuroimaging procedures is crucial. Magnetic resonance imaging with the assessment of perfusion and diffusion is the preferred method since it allows to detect the focus of ischemia in the first minutes of the disease. However, it can pose problems with uncooperative patients, especially children. A standard treatment for the acute phase of stroke in adults is intravenous thrombolysis. In the pediatric population, this treatment is only recently possible for use in patients aged 16 years and older.

Since patients with acute ischemic stroke, a medical emergency, are at a very high risk of death both during the acute phase and follow-up, identification of risk factors for post-stroke death in the first days after the acute ischemic event is especially needed. These factors can be divided into those related to the AIS itself, i.e., malignant brain edema, herniation, massive hemorrhagic, transformation of ischemic focus, and size of ischemic focus, and those related to therapeutic procedures and comorbidities. Such knowledge could influence the prevention and management of stroke, which in turn could improve the long-term survival rate.

The main scope of this special issue covers the critical overview of the advances in acute phase of brain ischemia in both adults and children.

Dr. Beata Sarecka-Hujar

Guest Editor

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