Overview

Stroke (sometimes called a cerebrovascular accident (CVA)) is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain, caused by a blocked or burst blood vessel. This can be due to ischemia (lack of glucose and oxygen supply) caused by thrombosis or embolism or due to hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs one side of body inability to understand or formulate speech, or inability to see one side of visual field A stroke is a medical emergency and can cause permanent neurological damage, complications, and death. It is the number two cause of death worldwide and may soon become the leading cause of death worldwide. Risk factors for stroke include advanced age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke.

A stroke is occasionally treated with thrombolysis ("clot buster"), but usually with supportive care (speech and language therapy, physiotherapy and occupational therapy) in a "stroke unit" and secondary prevention with antiplatelet drugs (aspirin and often dipyridamole), blood pressure control, statins, and in selected patients with carotid endarterectomy and anticoagulation. Classification A slice of brain from the autopsy of a person who suffered an acute middle cerebral artery (MCA) stroke Strokes can be classified into two major categories: ischemic and hemorrhagic. Ischemic strokes are those that are due to interruption of the blood supply, while hemorrhagic strokes are the ones which are due to rupture of a blood vessel or an abnormal vascular structure. 80% of strokes are due to ischemia; the remainders are due to hemorrhage. Some hemorrhages develop inside areas of ischemia ("hemorrhagic transformation"). It is unknown how many hemorrhages actually start off as ischemic stroke. Signs and symptoms Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases do not progress further. The symptoms depend on the area of the brain affected. The more extensive the area of brain affected, the more functions that are likely to be lost. Some forms of stroke can cause additional symptoms: in intracranial hemorrhage, the affected area may compress other structures. Most forms of stroke are not associated with headache, apart from subarachnoid hemorrhage and cerebral venous thrombosis and occasionally intracerebral hemorrhage.

Conventional Treatment

1. General treatment; a) quiet, absolute bed rest. The patient should be in the local rescue, not too many long-distance transportation and moving, so as not to increase bleeding; b) maintain the aspirate, oral secretions at any time or vomit.
2. Control cerebral edema and reduce increased intracranial pressure.
3. Control high blood pressure. Lowering increased blood pressure is an important measure to prevent further bleeding, but blood pressure should not drop too low to cause blood insufficiency. Generally maintain 20.0-21.3/12.0-3.3kpa (150-160/90-100mmhg) is appropriate.
4. Hemostatic and coagulation drugs have no effect on cerebral hemorrhage, but if the patient combined with gastric bleeding or coagulation disorder, they can be used.
5. To prevent and treat complications. Strengthening basic care should be taken for serious patients. The nurse shall pay attention to keep skin dry and clean, to prevent bedsores and pneumonia.

Limitations of Conventional Treatment

There are two major types of oral anticoagulant agents commonly prescribed for outpatients. The first and most widely used is the warfarin sodium Coumadin, which was ranked 29th among the "Top 200" drugs by prescription in 2001. Warfarin blocks the formation of prothrombin and other clotting factors involved in both the extrinsic and common coagulation pathways, and it prevents the metabolism of vitamin K to its active form in the synthesis of these factors. Warfarin has a characteristically slow onset of action. Therefore, when warfarin therapy is discontinued, it has a prolonged effect; its half-life is 36 hours, which could be the basis for the recommendation to discontinue the therapy for two to three days before dental treatment. Warfarin commonly is prescribed for patients who have prosthetic heart valves or a history of deep venous thrombosis; myocardial infarction, or MI; stroke; atrial fibrillation; or unstable angina. These drugs, especially aspirin, are used widely in the primary prophylaxis of coronary thrombosis, as well as in the secondary prevention of adverse thromboembolic events in patients with a history of coronary thrombosis, stroke and unstable angina

Stem Cell Treatment

As biotechnology advances, stem cell transplantation presents an advanced technology in treatment of severe brain and spinal cord injury. Stem cell transplantation can be divided into neurons to replace damaged nerve cells, and can secrete various neurotrophic factors and nerve growth factor to protect neurons and brain tissue to start neural stem cell functions. Transplantation of neural stem cells for acute phase of patients can effectively protect the damaged neurons which have remained functions. Brain cell transplantation : Neural stem cells were only until recently thought to be strictly embryonic. Many findings have proved this incorrect. The identification and localisation of neural stem cells, both embryonic and adult, has been a major focus of current research. Potential targets of neural stem cell transplants include stroke.

Indications of Stem Cell Treatment

Given the disease burden of stroke, prevention is an important public health concern. Primary prevention is less effective than secondary prevention (as judged by the number needed to treat to prevent one stroke per year). Recent guidelines detail the evidence for primary prevention in stroke. Because stroke may indicate underlying atherosclerosis, it is important to determine the patient’s risk for other cardiovascular diseases such as coronary heart disease. Conversely, aspirin prevents against first stroke in patients who have suffered a myocardial infarction or patients with a high cardiovascular risk. As the brain attack message is disseminated throughout our medical community and the awareness of the public increases, neurosurgeons will have the opportunity to treat patients with stroke at a much earlier time in the evolution of the process than we have been accustomed. Are the relatively unimpressive results of acute surgical intervention in patients operated on later in the course of the disease applicable to those who seek medical attention early, within the first few hours of ictus? There is little firm data. However, there is an overwhelming amount of anecdotal and experimental evidence supporting the potential for ultra-early intervention, which frequently should be surgical. New surgical techniques may improve safety and feasibility of emergent operations. In the coming years, diagnostic techniques such as perfusion/diffusion magnetic resonance imaging will allow the clinician to determine who may benefit from intervention. These determinations will be made on physiological data, addressing the issues of tissue viability and degree of compromise of the blood-brain barrier.

Advantages of Stem Cell Treatment

Stem Cells, may be pluripotent or multipotent, are important for living organisms for many reasons. Pluripotent stem cells can give rise to any type of cell in the body except those needed to support and develop a fetus in the womb. Stem cells that can give rise only to a small number of different cell types are called multipotent.

Neural Stem Cells (NSCs) are capable to self-renew and differentiate into neurons. When transplanted into the damaged site of brain, NSCs are able to differentiate into corresponding neural cells at the focus, and produce various neurotrophic factors. As the results, the damaged cells will be replaced, the nerve loop will be reconstituted and the degeneration of nerves or semi-apoptotic cells will be inhibited.

The advantages of the stem cells transplantation are followed:

• Relatively safe compare with most of the conventional treatments
• No immunological rejection, since stem cells have very low immunity
• Not affected by the blood-brain barrier, because stem cells are directly injected into the damaged tissues.

Advantages of Fetal Stem Cell Treatment

In the World Stem Cell Therapy Center, the stem cells used for most of our therapies are the Fetal Stem Cells (FSCs). FSCs treatment has a number of advantages compared with the transplantation of any other types of stem cells, i.e. adult, cord blood and animal stem cells.

1. Avoid the histocompatibility problems

   Histocompatibility has always been regarded as stumbling-block of transplantology, causing rejection of transplanted organs, bone marrow and cord blood stem cells, etc., thus requiring additional special methods aimed at suppression of the recipient’s immune system. With fetal stem cell transplantation, it is possible to avoid any side effects related to histocompatibility and ensure engraftment and proliferation of the administered cells, as well as their functioning in the body for many months and even years without immunosuppression.

2. Ensure both target and systemic effects

   In addition to targeted cell effects predicted and described by researchers, fetal stem cell transplantation can exert powerful systemic effects related to psychoemotional sphere, physical activity, immune system, homeostasis and functioning of internal organs, achieved via regulatory systems of the recipient’s body. Each type of stem cells produces certain specific tissues. Human regulatory systems, controlling the transplanted cells, guide the development and specialization of those cells in compliance with body needs, thereby ensuring precise specialization of clinical effects. Only natural tissues are used without any genetic engineering or cloning process for the cell cultures. The effects of the FSCs treatments are significantly different from most other medicinal treatments. Within 1 2 months after transplantation, early clinical effects of FSCs transplantation can be observed. The long-term effects of the FSCs treatments can be 6 3 years. In some cases, the engraftment will stay for lifetime.