Stroke
Stroke may occur due to reduction in the blood flow and oxygen transport to the brain after arterial occlusion (thrombus or embolus), arterial spasm, vessels rupture (aneurysm, hypertension), changes in blood viscosity, consequence of diabetes, or result of smoking, alcohol or obesity.
Hyperbaric oxygen therapy decreases blood viscosity and reduces clot formation as well as improves the deformability of the red blood cells making them more efficient in reaching distant capillaries.
Manifestations of stroke depending on the location of the neural damage could be: paralysis (hemiplegia or paraplegia), paresis, spasticity, flaccidity or muscle weakness, walking and balance impairment, intellectual and cognitive impairment (thinking understanding), speech impairment, memory disturbance (“vascular dementia”), sensitivity impairment, bladder and bowel dysfunction, sexual deficit.
Clinical application of hyperbaric oxygen (HBO) therapy in stroke has been widely used on experimental basis in acute stage as well as in the chronic stage – post stroke rehabilitation.
The benefit of HBO therapy in acute stage of stroke is due to the following:
- HBO prevents further brain damage by improving cerebral oxygenation and relieving brain edema and neuronal swelling
- HBO prevents further blood clotting by reducing blood viscosity and platelet aggregation
- HBO reduces mortality rate in those who survive stroke to below 20%
The benefit of HBO in rehabilitation in a chronic stage of stroke is due to the following:
- HBO reduces chance of stroke recurrences
- HBO relieves muscle spasticity and increases muscle strength
- HBO improves mobility and fine motor function
- HBO improves walking and balance
- HBO increases exercise capacity
- HBO improves sensitivity
- HBO improves mental function including speech and memory
- HBO improves visual acuity
- HBO improves bowel and bladder control and reduces sexual deficit
The reports of successful HBO therapy in chronic stroke have been mainly due to the possibility of oxygenation of the areas surrounding dead neuronal areas, which are anatomically intact but non-functional and have been dormant due to the initial lack of oxygen. These parts of brain called “ischemic penumbra” could possibly be reviewed with HBO, which would in turn initiate self-repair and establishment of lost connection due to the stroke. This would mean better mental and bodily functions.
References:
- Jain K: Textbook of Hyperbaric Medicine, 2nd ed. Hogrefe and Huber Publishers, Inc., 1996, Chap. 17: Role of hyperbaric oxygenation in management of stroke, Chap. 19: Hyperbaric oxygen therapy in neurosurgery.
- Akimov GA et al: Assessment of the efficiency of hyperbaric oxygen therapy in early forms of cerebrovascular disorders, Neurosci Behav Phys, 15:13-16, 1985.
- Nighoghossian N, Trouillas P, Adeleine P, Salord F: Hyperbaric oxygen in the treatment of acute ischemic stroke. A double- blind pilot study, Stroke, Aug; 26(8):1369-72, 1995.
- http://stroke.ahajournals.org/cgi/content/full/26/8/1369#BDY
- Veltkamp R, Toole JF: Hyperbaric oxygen-a neuroprotective adjuvant for hyperacute ischemic stroke? J Neurol Sci, Sep, 1; 150(1):1-2, 1997.
- Watanabe M, Kanaya H, Fuchizawa K, Onodera H, Suzuki H.: Experimental study on compressed air therapy on cerebral edema, Jap. J. Hyperbaric Medicine 5: 23, 1970
- Marroni A: Hyperbaric oxygen therapy at 1.5 or 2.0 ATA as an adjunct to the rehabilitation of stabilized stroke patients. A controlled study, 9th International Congress on Hyperbaric Medicine, Sydney, Australia: March 1-4, pp: 161-167, 1987.
- Steenblock D: Review of Hyperbaric Oxygen for Stroke Rehabilitation, Explore, Volume 7, Number 5, 1996/97.
- Sukoff MH, Ragatz RE: Hyperbaric oxygenation for the Treatment of Acute Cerebral Edema, Neurosurgery, 10:29-38, 1982
- Holbach KH et al: Reversibility of the chronic post-stroke state, Stroke , 7 (3) 296-300, 1976.
- Holbach KH et al: Differentiation between reversible and ireversible post-stroke changes in brain tissue: Its relevance for cerebraovascular surgery, Surg Neurol, 7: 325-331, 1977.
- Neubauer RR: Hyperbaric Oxygen and Imaging Techniques in Diagnosis and Therapy of Stroke. Does the Ischemic Penumbra alter the outcome in Stroke?, International Symposium: Neuropsychomotor, Neuropharmacological, Psychosocial and Ethical Aspects, Oct. 7-11,1992 Siracusa, Italy. pp 1-9.
- Neubauer RR: Hyperbaric Oxygenation in acute stroke- 4 hour window, EUBS, 26th Annual meeting, Malta, Sep 14-18, pp:43-4650, 2000.
- Neubauer RR: World Federation of Neurology proposed pilot study of hyperbaric treatment of acute ischemic thrombotic stroke , EUBS, 25th Annual meeting, Haifaand Eilat, Israel, Aug 28 -Sep 2, pp:48-51, 1999.
- Li W: Cerebral thrombosis treated by hyperbaric oxygenation, 9th International Congress on Hyperbaric Medicine, Sydney, Australia, March 1-4, pp 153-154, 1987.
sumber : http://baromedical.ca/medical/neurological/stroke/
