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Cerebral perfusion and stroke
  1. H S Markus
  1. Correspondence to:
 Professor Hugh Markus
 Clinical Neuroscience, St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK;


Stroke is a heterogeneous syndrome caused by multiple disease mechanisms, but all result in a disruption of cerebral blood flow with subsequent tissue damage. This review covers the mechanisms responsible for regulation of the normal cerebral circulation, and how they are disrupted in disease states. A central concept in treating patients with acute ischaemic stroke is the existence of an ischaemic penumbra of potentially salvageable tissue, and the evidence for its existence in humans is reviewed.

  • stroke
  • cerebrovascular disease
  • cerebral blood flow
  • ischaemic penumbra
  • cerebral circulation
  • ADC, apparent diffusion coefficient
  • AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazole
  • CBF, cerebral blood flow
  • CBV, cerebral blood volume
  • CMRo2, cerebral metabolic rate of oxygen
  • CPP, cerebral perfusion pressure
  • CVR, cerebrovascular resistance
  • DWI, diffusion weighted imaging
  • eNOS, endothelial nitric oxide synthase
  • IMP, inosine 5′-monophosphate
  • iNOS, inducible nitric oxide synthase
  • MTT, mean transit time
  • NMDA, N-methyl-D-aspartate
  • nNOS, neuronal nitric oxide synthase
  • NOS, nitric oxide synthase
  • OEF, oxygen extraction fraction
  • PET, positron emission tomography
  • SPECT, single photon emission computed tomography
  • 99mTcHMPAO, technetium-99m hexamethylpropylene amine oxime
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  • Competing interests: none declared

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