PDF(Pubmed)
Abstract：
In human stroke, brain swelling is an important predictor of neurological outcome and mortality, yet treatments to reduce or prevent brain swelling are extremely limited, due in part to an inadequate understanding of mechanisms. In preclinical studies on cerebroprotection in animal models of stroke, historically, the focus has been on reducing infarct size, and in most studies, a reduction in infarct size has been associated with a corresponding reduction in brain swelling. Unfortunately, such findings on brain swelling have little translational value for treating brain swelling in patients with stroke. This is because, in humans, brain swelling usually becomes evident, either symptomatically or radiologically, days after the infarct size has stabilized, requiring that the prevention or treatment of brain swelling target mechanism(s) that are independent of a reduction in infarct size. In this problematizing review, we highlight the often-neglected concept that brain edema and brain swelling are not simply secondary, correlative phenomena of stroke but distinct pathological entities with unique molecular and cellular mechanisms that are worthy of direct targeting. We outline the advances in approaches for the study of brain swelling that are independent of a reduction in infarct size. Although straightforward, the approaches reviewed in this study have important translational relevance for identifying novel treatment targets for post-ischemic brain swelling.
摘要：
在人类中风中，脑肿胀是神经系统预后和死亡率的重要预测指标，然而，减少或预防脑肿胀的治疗方法非常有限，部分原因是对机制的理解不足。在中风动物模型的脑保护的临床前研究中，历史上,重点是减少梗死面积，在大多数研究中，梗死面积的减少与脑肿胀的相应减少有关.不幸的是,这些关于脑肿胀的发现对于治疗中风患者的脑肿胀几乎没有转化价值。这是因为,在人类中,脑肿胀通常变得明显，无论是症状还是放射学，梗死面积稳定后几天，要求预防或治疗脑肿胀的目标机制独立于梗死面积的减少。在这个有问题的审查中，我们强调了一个经常被忽视的概念，即脑水肿和脑肿胀不仅仅是继发性的，中风的相关现象，但具有独特分子和细胞机制的独特病理实体，值得直接靶向。我们概述了研究脑肿胀的方法的进展，这些方法与梗死面积的减少无关。虽然直截了当，本研究中综述的方法对于确定缺血性脑肿胀的新治疗靶点具有重要的翻译相关性.
