Selective therapeutic cooling: To maximize benefits and minimize side effects related to hypothermia

Selective therapeutic cooling is a promising technique for reducing final infarct volume and improving outcomes in ischemic stroke, especially as research regarding brain reperfusion continues to be explored. A recent study provided promising results on the safety and feasibility of selective therapeutic hypothermia via a closed-loop cooling catheter system for intra-carotid blood cooling in an ovine stroke model, but they failed to find efficacy of this method in this model. It is a major step forward from bench to bed side, but enhancing benefits of selective therapeutic cooling may need to take into account a more targeted induction of brain hypothermia and should mitigate potential side effects related to inducing hypothermia.

Evaluating the translational value of postmortem brain reperfusion technology

A novel pulsatile-perfusion technology, dubbed BrainEx, has been shown to restore microcirculation and cellular functions in the pig brain, 4 h postmortem. This technology has generated enthusiasm for its translational value for human neuroresuscitation. I offer a critical analysis of the study and its methodology, providing several reasons for skepticism. This includes: all phenomena were observed at different degrees of hypothermia; the physiological and biochemical milieu of the experimental preparation is radically different than the clinical setting of hypoxic-ischemic brain injury; and the study is confounded by uncontrolled traumatic brain injury and lifelong stress in all the animals.

THE EFFECT OF CITICOLIN IN MOTORIC IMPROVEMENT OF ACUTE ISCHEMIC STROKE PATIENTS IN SITI KHODIJAH SEPANJANG HOSPITAL

ABSTRACT Background: According to WHO, stroke is the leading cause of morbidity and the second cause of death with a mortality rate of around 5.54 million. Stroke, based on its etiology, consists of ischemic and hemorrhagic. Ischemic stroke is caused by a blockage in the blood-brain, whereas hemorrhagic stroke occurs due to the rupture of brain blood vessels. Based on the pathophysiology of ischemic stroke, its therapy consists of thrombolytic in thrombus for brain reperfusion and anticoagulants or antiplatelet in strokes due to embolization because it is grown in a collateral-containing lavatory and neuroprotectant assistance to trace cytotoxic nerves. Neuroprotectants that are often used are piracetam and citicoline. Citicoline improves neuronal cell membranes by increasing synthesis of the main component of cell membranes, phosphatidylcholine, then repaired neuronal cell membranes. Objective: To find out motor improvement in stroke patients at Siti Khodijah Sepanjang Hospital by giving 500mg of citicoline per day orally for 5 days. Methods: A case-control observational analytic study using medical record data. Consists of a group with standard therapy, antiplatelets, and another group with 500mg/day antiplatelet and citicoline therapy for 5 days. Patients were examined for MRC motor on the first day and the fifth day. Results: The statistical test used the Chi-Square test and wilcoxon test with a significance value of 0.00 and 0,01 (<0.05). Conclusion: obtained significant motor improvement in stroke patients 500mg/day for 5 days at Siti Khodijah Sepanjang Hospital. Keywords: Citicoline, Motoric Repair, Ischemic Stroke ABSTRAK Latar belakang: Menurut WHO stroke menjadi penyebab utama morbiditas dan sebab kematian nomor dua dengan angka kematian sekitar 5,54 juta. Stroke berdasarkan etiologinya diklasifikasikan menjadi stroke iskemik dan stroke hemoragik. Stroke iskemik merupakan stroke yang diakibatkan oleh adanya sumbatan pada pembuluh darah di otak sedangkan stroke hemoragik akibat adanya pecahnya pebuluh darah otak. Berdasarkan patofisiologinya terapi stroke iskemik terdiri dari trombolitik pada iskemik akibat trombus untuk reperfusi otak dan antikoagulan atau antiplatelet pada stroke akibat emboli sebagai pencegahan terbentuknya trombus pada pembuluh darah kolateral serta pemberian neuroprotektan untuk menghambat penyebaran kerusakan neuroglia pada penumbra akibat proses sitotoksik. Neuroprotektan yang sering digunakan adalah pirasetam dan citicolin. citicolin berfungsi memperbaiki membran sel neuron dengan meningkatkan sintesis komponen utama membran sel yaitu phosphatidylcholine sehingga terjadi peningkatan perbaikan membran sel neuron. Tujuan: Untuk mengetahui perbaikan motorik pada pasien stroke iskemik akut di RS Siti Khodijah Sepanjang. Metode: Jenis penelitian analitik observasional case-control bersifat retrospektif menggunakan data rekam medis. Terdiri dari kelompok dengan terapi standar yaitu antiplatelet dan kelompok lain dengan terapi antiplatelet dan citicolin 500mg/hari selama 5 hari. Pasien dilakukan pemeriksan motorik MRC di hari pertama dan hari kelima. Hasil: Uji statistik menggunakan uji Chi-Square dan uji wilcoxon dengan nilai signifikansi masing-masing 0,00 dan 0,01 (<0,05). Kesimpulan: didapatkan perbaikan motorik yang signifikan pada pasien stroke iskemik akut dengan pemberian citicoline 500mg/hari selama 5 hari di Rumah Sakit Siti Khodijah Sepanjang. Kata Kunci: Citicolin, Perbaikan Motorik, Stroke Iskemik

Rapid Brain Death following Cardiac Arrest without Intracranial Pressure Rise and Cerebral Circulation Arrest

We describe here an unusual case of brain death following cardiac arrest. Brain electric activity had totally ceased, allowing the confirmation of brain death, despite normal cerebral blood flow (assessed by both transcranial doppler and tomodensitometry) and no evidence of intracranial hypertension. In our case, a residual electric activity was assessed at admission and lesions worsened on imaging during ICU stay, suggesting that part of the neuronal damage occurred after brain reperfusion. All these elements suggest BD rather by cellular toxicity than intracranial pressure elevation.