Reperfusion Injury Of The Brain In Ischemic Stroke: From Pathophysiology To Clinical Manifestation

Abstract

A prospective study was conducted on 67 patients with ischemic stroke who underwent systemic intravenous thromboembolism (SILT). Depending on the course of the postreperfusion period, the patients were divided into two groups: the first group consisted of 48 patients who did not develop reperfusion syndrome, and the second group consisted of 19 patients with clinical manifestations of SILT. In patients without SILT, significant improvement in neurological status was observed as early as 24 hours after SILT: the level of consciousness according to the GCS increased from 10.3±1.2 to 13.8±1.2 points, reaching 14.1±0.9 points by day 7 (p<0.005), while the NIHSS decreased from 14.2±1.8 to 6.3±1.5 points after 24 hours and to 5.2±2.1 points by day 7 (p<0.005). In contrast, patients with ischemic stroke experienced early clinical deterioration, accompanied by hyperthermia, worsening neurological deficit, impaired consciousness, seizures, and hemodynamic and respiratory distress. The GCS decreased from 10.6±2.4 to 9.3±3.5 points after 24 hours and reached 10.1±4.5 points on day 7, while the NIHSS increased from 14.9±3.5 to 18.3±4.1 points after 24 hours and remained high (16.1±4.5 points) on day 7. The development of reperfusion syndrome after systemic thrombolytic therapy is associated with early neurological deterioration and unfavorable dynamics of clinical parameters, reflecting the progression of ischemia-reperfusion brain injury.