ISKEMA

Why this site?

The name of this website (ISKEMA) is derived from a combination of the following words: ISchemic, stroKE, edeMA.
This website offers a "library" of publications on the pathophysiology and therapy of the brain edema, chiefly originating from ischemic attacks.

The goal of this website is to improve our knowledge of the medical management of brain edema; especially what emerges in patients with large Hemispheric infarction-associated edema (LHIAE) ( Frank, 1995 ).
The intention is to provide current publications on osmotic therapies (OTs) in order to increase ours knowledge and to minimize the side effects of this medical therapy which can be lethal in some cases and to optimize one standard regime ( see Protocol Theraphy section) to finally discontinue it or to use it with more safety and efficiency.

In daily practice OTs are used in different ways such as times per day,concentration and different pathologicals states ( e.g., ischemics, traumas, hemorrhages, other).
No evidence indicates that mannitol or glycerol or other measures that reduce intracranial pressure ( ICP) alone improve outcome in patients with ischemic brain swelling ( Jauch et al.,2013).

In spite of this absence of evidence of effectiveness for medical therapy with OTs, those therapies are utilized every day in neurocritical care unit and other neurological center of care.

The scope of this website is to come out of the "mist" of evidence in this therapeutical practice ( Lomas and Lavis,1996 ).

We believe that this therapeutical approach ( OT in LHIAE ) now appears to be in the gray zone of evidence. In this website we have put articles on the ischemic brain edema , particularly the medical therapies with hypertonic saline and/or mannitol in patients with acute deterioration by LHIAE and i propose to do a multicentric trial ( see Trial section ) with one regular regime of these medical therapies.

Only a multicentric collaboration can say the last word on this medical management of LHIAE.
Such project can only be done by close collaboration between the clinicians ( neurointensivist and not ) in this era of wide spread of neurocritical care units in the world.