Cerebral Atherothrombosis

The complete occlusion of an artery may lead to an ischemic infarction, an area of necrotic cells caused by the obstruction of blood flow.

Thrombosis may take place in a few minutes or take hours or even days to fully evolve. A stroke that is actively progressing as a direct result of increasing occlusion and ischemia is termed stroke in evolution of progressing stroke [Aminoff MJ, et al. Clinical Neurology. 3rd Edition. Stamford, Conn., Appleton and Lange, 1996]. A large blood vessel (e.g., carotid, middle cerebral, and basilar arteries) can take longer to become occluded than a smaller vessel (e.g., lenticulostriate, basilar penetrating, and medullary arteries), and there may be warning signs. One of the most important is a transient ischemic attack (TIA).

In an ischemic stroke, damage to the brain may not only result from infarction but also from cerebral edema, an excessive accumulation of fluid in the brain. Cerebral edema peaks at approximately 2 to 5 days after onset of the stroke. Then, accumulation of fluid usually stabilizes and may lessen.

Acute Ischemic Stroke: New Concepts of Care
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