Recent advances in the diagnosis and treatment of stroke

Modern Emergent Stroke Imaging: Pearls, Protocols, and Pitfalls

Stroke remains one of the most important clinical diagnoses for which patients are referred to the radiologist for emergent imaging. Timely and accurate imaging guides admission from the emergency department or transfer to a hospital with a dedicated stroke service, triage to the intensive care unit, anticoagulation, thrombolysis, and many other forms of treatment and management. It is important to approach each patient's imaging needs logically and tailor each work-up, and constantly to review the entire process for potential improvements. Time saved in getting an accurate diagnosis of stroke may indeed decrease morbidity and mortality. This article discusses the current management of stroke imaging and reviews the relevant literature.

Death-associated protein kinase as a potential therapeutic target

Death associated protein kinase (DAPK) is a calmodulin (CaM)-regulated serine/threonine protein kinase implicated in diverse apoptosis pathways, including those involved in neuronal cell death and tumour suppression. The requirement of DAPK catalytic activity for its proposed cell functions and the validation of protein kinases as therapeutic targets demand that DAPK be examined as a potential therapeutic target in human disease. The relevant placement of DAPK activity in apoptosis pathways is at an early stage of investigation, making its study as a therapeutic target tenuous. However, the current body of knowledge raises the possibility of DAPK as a therapeutic target for diseases characterised by rapid neurodegeneration, such as stroke or traumatic brain injury. The unmet need in these diseases is for an acute treatment schedule that might reduce neuronal loss. Bioavailable inhibitors of DAPK catalytic activity that target the central nervous system have a potential to fill this need. The development of such DAPK inhibitors is now feasible based on the recent emergence of enabling technology and knowledge. These include a quantitative and selective enzyme assay, a high resolution structure of the active catalytic domain and discovery of cell-permeable, low molecular weight inhibitors of CaM kinases that cross the blood-brain barrier. DAPK as a potential therapeutic target for cancer is less attractive due to the incomplete state of knowledge about DAPK and inherent limitations in drug development for the discovery of specific activators of genes downregulated by promoter hypermethylation. This article provides a brief summary of relevant research and the rationale that is at the foundation of this opinion.

A mathematical model of post-canalization thrombolysis

During the initial phase of lysis of an occlusive thrombus using lytic agents such as tissue plasminogen activator, blood flow through the centre of the clot is established (the process of recanalization). Following canalization, the clot remains on the vessel wall and further lysis is required. This paper develops a multi-species mathematical model to describe the bulk chemical reactions in the bloodstream and the convective and diffusive transport of chemical species to and from the clot surface in conditions following canalization. For the steady state case, the model indicates that the process of clot lysis following initial recanalization is dominated by surface chemical reactions and the bulk reactions play little role in the lytic process. Lytic rate is dependent on the clot geometry and flow conditions. The rate of clot dissolution is greatest at the upstream end of the clot and decreases steadily downstream due to lytic agent being removed from the flowing blood as it binds to the clot surface. This model may be further developed and used to simulate and compare different lytic regimes.