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(Stroke. 2006;37:10.)
© 2006 American Heart Association, Inc.

Editorial

The Time Man Has Cometh to Brain

Tick ... Death .... Tick ... Death

Steven R. Levine, MD

From the Stroke Center and Department of Neurology Mount Sinai School of Medicine.

Correspondence to Steven R. Levine, MD, Mount Sinai Stroke Center Department of Neurology Box 1137, Annenberg 14-66 Mount Sinai School of Medicine, One Gustave L. Levy Place New York, NY 10029-6574. E-mail steven.levine@mssm.edu

Key Words: acute stroke • brain imaging • brain infarction

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 263–266.

The stroke community has been chanting the qualitative battlecry of "time is brain" for 12 years¹ and has been able to act directly on it for a decade.² Now, Saver³ has thoughtfully and critically synthesized a quantitative face on one of the most important aspects of acute stroke care: getting an eligible patient treated with intravenous tissue plasminogen activator as soon as possible because each minute that ticks away without treatment equates to about an additional 2 million neurons lost.

Developing a quantitative approach to time-specific ischemic brain damage in humans is an elegant concept with tremendous implications for treatment and future clinical trial design. Saver systematically modeled a typical supratentorial, large artery infarct volume over time using various, readily available, neuroanatomic and physiological data. This allowed the first detailed analysis of how much brain substance is lost (with coefficients of variation) over various units of time based on the best available (albeit, at times, incomplete) information. He then performed sensitivity analyses to address the robustness of the model.

One implication from Saver’s analysis is that true and pure transient ischemic attacks may be much rarer than believed because even after a few seconds of the focal cerebral ischemic process, tens of thousands of neurons and hundreds of millions of synapses are lost - if the time function is linear. Are these very brief episodes really then "microstrokes" (invisible to the neurological examination or current imaging modalities) with very subtle, if any detectable parenchymal . . . [Full Text of this Article]

Related Article:

Time Is Brain—Quantified

Jeffrey L. Saver
Stroke 2006 37: 263-266. [Abstract] [Full Text] [PDF]