Pathogenesis

Infarction of neural material is more devastating than that of other tissues because:

• anatomical regions within the brain have unique functions, the brain becoming less plastic with age
  
  
• neurones have a high oxygen requirement with no ability to respire anaerobically and die if rendered hypoxic for more than a few minutes
  
  
• neuronal death results in the uncontrolled release of large amounts of neurotransmitter:
  • this may result in toxic damage to other neurones, causing further release of transmitters, and so on
  • attempts to prevent this cascade of neuronal death with glutamate receptor antagonists of calcium channel blockers have been successful in lab animals, but to date, the results have not been reproduced in man

Reference

1. Adams HP Jr, Bendixen BH, Kappelle LJ, et al; TOAST Investigators. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial (TOAST - Trial of Org 10172 in Acute Stroke Treatment). Stroke. 1993 Jan;24(1):35-41.