The maturation phenomenon, first described by Ito et al. in 1975, refers to postischemic changes that develop hours or days after an ischemic insult. The delayed neuronal death of CA1 pyramidal cells of the hippocampus is a classic example. The report of the phenomenon boosted research in the field, as it became evident that ischemic damage is not a sudden event, but a process potentially susceptible to therapeutic intervention. Since then a growing number of studies have improved our knowledge on mechanisms of cell death and recovery. This volume contains the presentations of the 4th international symposium, held in New Orleans in October/November 1999, grouped in sections covering apoptosis and/or necrosis, neuronal recovery vs. death, and protection against infarction. It outlines the present status of investigations and provides further stimulation for research in this field.

The Maturation Phenomenon, described by Ito et al. in 1975 [3) on the basis of his to logical observations in the hippocampus as well as other portions of the cerebral hemisphere, refers to the hours or days of delay in the development of pathological changes in various parameters of ischemic injury following the restoration of blood flow to the ischemic brain. There is a direct relationship between the intensity of ischemic insult and the speed and rate of maturation of ischemic injury, a lesser intensity being associated with slower and less severe development of the lesions. The delayed neuronal death of CAl pyramidal cells of the hippocampus [8) is a classic example. In the cerebral cortex, with increasing intensity of the ischemic insult, the maturation phenomenon of ischemic injuries intensifies, seamlessly, from less exten sive to more extensive disseminated selective neuronal necrosis (DSNN), and then further to cerebral infarction upon reaching a critical threshold [1,2,4,6,7). We also have found that following ischemic insults just under the threshold level required to induce infarction, only disseminated selective neuronal necrosis (DSNN) progresses, while following ischemic insults at the threshold level, initially only DSNN develops, followed by the evolution of a gradually enlarging infarcted focus [5, 7). The reporting of this phenomenon boosted research in the field, as it became evi dent that ischemic damage is not a sudden event, but a process potentially susceptible to therapeutic intervention.

Many nerve cells of the brain which are not killed outright may suffer delayed death or recovery after ischemic insult. This fact has led to the concept of "maturation phenomenon" of neuronal injuries. Since the 1st International Symposium on Maturation Phenomenon in 1990, new developments, particularly in molecular biology, have been rapidly bringing new information about molecular nature and mechanisms of cell death. This book contains the presentations of the 2nd International Symposium held in Tokyo in April 1996. The latest developments in maturation phenomenon and the present status of investigation are described and further stimulation of research in this field is provided.

It has been well recognized that following an ischemic insult many nerve cells of the brain are not killed outright, but may suffer a "delayed neuronal death" or even recover. This led to the concept of "maturation phenomenon" with its main implication that the maturation of ischemic lesions may provide a "window of opportunity" i.e. a period of time when the injury to neuronal elements is still reversible, and during which an application of proper therapeutic measures might be successful. The symposium on Maturation Phenomenon in Cerebral Ischemia was the first international meeting focussed primarily on this subject and the resulting publication contains presentations and discussionsby prominent researchers engaged in this field. This book should stimulate further research on potential of brain tissue for recovery, and particularly with regard to a functional recovery of neurons suffering from chronic ischemic injury.

This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.

Brain edema is a simple phenomenon – an abnormal increase of brain tissue volume by the increase of brain tissue water content. However the etiology is not simple and relating to a wide variety of neurological disorders including ischemia, trauma, tumor, hemorrhage and hydrocephalus. It is still a major cause of death in the neurological/neurosurgical ward. This volume is an up-to-date report on progress in brain edema research, diagnosis and treatment, including papers presented at the 12th International Symposium on Brain Edema and Brain Tissue Injury in 2002. Major topics include molecular biology and blood-brain barrier disorders, ischemic and traumatic brain edema, imaging and diagnosis of brain edema, treatment and radiation effect. Various papers in the rapidly growing fields of neuroimaging and molecular medicine are also included.

Covering neuroscience and rehabilitation strategies, an essential handbook and reference for multidisciplinary stroke rehabilitation teams.