Pathobiology of injury after stroke: the neurovascular unit and beyond

Throughout the history of research on stroke pathophysiology, focus has shifted from purely vascular concepts to the insight that a complex interplay of biochemical and molecular mechanisms involving practically any cell type of the brain (“neurovascular unit”) partakes in either salvage or demise o...

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Bibliographic Details
Published in:Annals of the New York Academy of Sciences 2012-09, Vol.1268 (1), p.21-25
Main Author: Dirnagl, Ulrich
Format: Article
Language:English
Subjects:
Age
Animals
Astrocytes - pathology
Basement Membrane - pathology
Biochemistry
Brain
Brain - immunology
Brain - pathology
Brain - physiopathology
Brain Ischemia - immunology
Brain Ischemia - pathology
Brain Ischemia - physiopathology
Cerebrovascular Circulation
complications
Disease Models, Animal
Endothelial Cells - pathology
Extracellular Matrix - pathology
Forecasting
Humans
Immune systems
Immunocompromised Host
Infection - etiology
Medical
Myocytes, Smooth Muscle - pathology
Nerve Tissue Proteins - physiology
Neurons - pathology
neurovascular unit
Patients
Pericytes - pathology
Salvage
Sarcopenia - etiology
Stroke
Stroke - complications
Stroke - immunology
Stroke - pathology
Stroke - physiopathology
stroke pathophysiology
stroke unit
Strokes
supersystems
systemic effects
translational roadblock
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Summary:Throughout the history of research on stroke pathophysiology, focus has shifted from purely vascular concepts to the insight that a complex interplay of biochemical and molecular mechanisms involving practically any cell type of the brain (“neurovascular unit”) partakes in either salvage or demise of the tissue after a stroke. In addition, it was realized that peripheral immune cells play important roles, not only after their invasion into the brain but also because of stroke‐induced effects on the immune system that can result in infections. Indeed, outcome of stroke patients is not only dictated by nonmodifiable factors, such as severity of stroke, age, or premorbidity, but also by modifiable factors largely related to medical complications, such as infections and possibly sarcopenia. The highly successful concept of stroke units attests to the benefits of treating stroke comprehensively. Breakthroughs in improving outcome after stroke will only result from approaches that target not only the brain, but also systemic effects of stroke.
ISSN:0077-8923
1749-6632
DOI:10.1111/j.1749-6632.2012.06691.x