Holiday penumbras

In anticipation of my upcoming lab rotation at the Centre for Stroke Research in Berlin, I have been reading up on the focus of my project.
The ischemic penumbra is an area of a stroke patient’s brain which is dying as a result of the blockage of one of the arteries supplying the tissue. The keyword here is dying, not quite dead yet unlike the core of the tissue affected – which makes it a prime target for salvation in terms of stroke treatment. Left untreated, this penumbra transforms into dead brain tissue, and thus contributes to the patient’s permanent symptoms or neurological deficit. The region, which cannot be readily seen on more conventional imaging techniques like CT or standard MRI, was first noticed in PET scans, which basically measure the amount of energy the brain uses and maps it onto an image. Now, with the availability of more sophisticated MRI techniques such as diffusion and perfusion weighted imaging, this area can be mapped and its natural history identified, but most important is the fact that its response to treatment can be established. Simply, can this area be saved and to what degree, is the question on our minds.
The group which I am going to be working with has made much progress in this field, and what drew me to their projects most was their unique and innovative approach to the subject of stroke, which is a major killer and prominent cause of disability worldwide. For example, every doctor knows that stroke has a relatively short time window in which treatment can be given, and more importantly it is within this time window, typically around three hours from the onset of the stroke, that benefits of the treatment outweigh the risks. This time window was derived years ago from large studies which showed that only patients who received treatment within this time benefited from it. But now people are thinking of a new approach. Researchers are now trying to replace this seemingly arbitrary number of three hours with more objective and reliable criteria such as various signs on MRI, so that everyone who might benefit from treatment but falls outside of this window can have the opportunity to end up with less permanent disability than if doctors only relied on the time from stroke onset.
Needless to say I am very excited at the prospect of participating in something which has the potential to be so groundbreaking! Which is why I feel the need to be prepared, and that’s what I’m spending my holiday attempting to do. I will be posting more about this soon! 🙂

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