Transcranial Direct Current Stimulation in Hyperacute Ischaemic Middle Cerebral Artery Infarction: Impact on Outcom

Abstract

Cerebrovascular stroke (CVS) has been known to physicians for 2,400 years with an accumulating knowledge about its pathophysiology that keeps increasing everyday. It was not until last century when the vascular pathophysiology became widely accepted and most of stroke research have been directed towards understanding and influencing the vascular cascade since then. In spite of all efforts, CVS is still the leading cause of disability and the second cause of death worldwide. Less than 10 years ago, a breakthrough took place in the understanding of CVS pathophysiology when cortical spreading depression (CSD) was recorded for the first time in human ischaemic penumbra. This provided clear evidence that the pathophysiology of CVS involves massive electrical events alongside the vascular cascade. Such phenomena were termed peri-infarct depolarization (PID) when it occured within ischaemic penumbra. Evidence showed that PIDs lead to excitotoxicity and increased edema within