Cao Zhijuan, Harvey Sean S, Bliss Tonya M, Cheng Michelle Y, Steinberg Gary K
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.
Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States.
Front Neurol. 2020 Apr 7;11:236. doi: 10.3389/fneur.2020.00236. eCollection 2020.
Stroke is one of the major causes of chronic disability worldwide and increasing efforts have focused on studying brain repair and recovery after stroke. Following stroke, the primary injury site can disrupt functional connections in nearby and remotely connected brain regions, resulting in the development of secondary injuries that may impede long-term functional recovery. In particular, secondary degenerative injury occurs in the connected ipsilesional thalamus following a cortical stroke. Although secondary thalamic injury was first described decades ago, the underlying mechanisms still remain unclear. We performed a systematic literature review using the NCBI PubMed database for studies that focused on the secondary thalamic degeneration after cortical ischemic stroke. In this review, we discussed emerging studies that characterized the pathological changes in the secondary degenerative thalamus after stroke; these included excitotoxicity, apoptosis, amyloid beta protein accumulation, blood-brain-barrier breakdown, and inflammatory responses. In particular, we highlighted key findings of the dynamic inflammatory responses in the secondary thalamic injury and discussed the involvement of several cell types in this process. We also discussed studies that investigated the effects of blocking secondary thalamic injury on inflammatory responses and stroke outcome. Targeting secondary injuries after stroke may alleviate network-wide deficits, and ultimately promote stroke recovery.
中风是全球慢性残疾的主要原因之一,越来越多的研究致力于探讨中风后脑修复和恢复的机制。中风后,原发性损伤部位会破坏附近和远距离连接的脑区的功能连接,导致继发性损伤的发生,这可能会阻碍长期功能恢复。特别是,皮质中风后同侧丘脑会发生继发性退行性损伤。尽管继发性丘脑损伤在几十年前就已被首次描述,但其潜在机制仍不清楚。我们使用NCBI PubMed数据库进行了系统的文献综述,以查找专注于皮质缺血性中风后继发性丘脑变性的研究。在本综述中,我们讨论了一些新出现的研究,这些研究描述了中风后继发性变性丘脑中的病理变化;这些变化包括兴奋性毒性、细胞凋亡、淀粉样β蛋白积累、血脑屏障破坏和炎症反应。特别是,我们强调了继发性丘脑损伤中动态炎症反应的关键发现,并讨论了几种细胞类型在此过程中的作用。我们还讨论了研究阻断继发性丘脑损伤对炎症反应和中风结局影响的研究。针对中风后的继发性损伤可能会减轻全网络的缺陷,并最终促进中风恢复。