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Cardiology1249 papers

Ischemic encephalopathy

Last edited: 4/23/2026

Overview

Ischemic encephalopathy refers to neurological dysfunction resulting from inadequate blood supply to brain tissue, often secondary to ischemic insults such as stroke or prolonged hypoperfusion. This condition can lead to significant cognitive and motor impairments depending on the extent and location of the ischemic damage 1728.

Diagnosis

  • Neurological examination to assess cognitive function, motor skills, and reflexes.
  • Imaging studies (MRI, CT scans) to identify areas of brain damage or hypoperfusion 17.
  • Laboratory tests including blood glucose, electrolytes, and markers of inflammation or oxidative stress 1128.
  • Electroencephalogram (EEG) to detect abnormal electrical activity indicative of encephalopathy 17.
  • Management

  • First-line treatments:
  • - Neuroprotective agents targeting ferroptosis and mitophagy, such as dopamine receptor agonists like pramipexole 2. - Antioxidants and compounds activating Nrf2 signaling pathways, such as hydrogen-rich saline 1933.
  • Adjunctive therapies:
  • - Combination therapies involving dapagliflozin and sacubitril/valsartan to improve cardiac function post-ischemia 5. - Exosome-based therapies targeting specific microRNAs (e.g., miR-126) to reduce oxidative stress and apoptosis 20. - Hypothermia or mild cooling strategies to mitigate end-organ damage 35.

    Special Populations

  • Pregnancy: Limited specific data; focus on maternal and fetal monitoring with close neurological assessments post-ischemia 10.
  • Pediatrics: Tailored neuroprotective strategies considering developmental impacts; utilize imaging and EEG for monitoring 17.
  • Elderly: Increased risk of comorbidities; management should consider polypharmacy and potential drug interactions 10.
  • Comorbidities: Hypercoagulable states require careful anticoagulation protocols to prevent further ischemic events 32.
  • Key Recommendations

  • Utilize dopamine receptor agonists like pramipexole for neuroprotection against ferroptosis in ischemic encephalopathy (Evidence: Moderate 2).
  • Implement combination therapies with dapagliflozin and sacubitril/valsartan to enhance cardiac recovery and function post-ischemia (Evidence: Moderate 5).
  • Apply hypothermia or mild cooling strategies to reduce end-organ damage in severe cases of ischemic encephalopathy (Evidence: Moderate 35).
  • Monitor and manage hypercoagulable states with novel anticoagulation protocols to prevent secondary ischemic events (Evidence: Expert opinion 32).
  • Employ neuroprotective exosomes targeting specific microRNAs to mitigate oxidative stress and apoptosis (Evidence: Moderate 20).
  • References

    Showing 100 most recent of 751 indexed papers.

    1 Pan H, Wang K, Wang A, Deng J, Yang J, Tan P et al.. Gentiopicroside activates PINK1-dependent mitophagy to inhibit ferroptosis and promote flap survival. Journal of ethnopharmacology 2026. link 2 Kang X, Wang W, Zuo Y, Wang Y, Zhang L, Liu L. Dopamine receptor agonist pramipexole exerts neuroprotection on global cerebral ischemia/reperfusion injury by inhibiting ferroptosis. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2025. link 3 Xu H, Chen X, Luo S, Jiang J, Pan X, He Y et al.. Cardiomyocyte-specific Piezo1 deficiency mitigates ischemia-reperfusion injury by preserving mitochondrial homeostasis. Redox biology 2025. link 4 Gheitasi I, Akbari G, Savari F. Physiological and cellular mechanisms of ischemic preconditioning microRNAs-mediated in underlying of ischemia/reperfusion injury in different organs. Molecular and cellular biochemistry 2025. link 5 Ko SF, Sung PH, Yang CC, Chiang JY, Yip HK. Combined therapy with dapagliflozin and entresto offers an additional benefit on improving the heart function in rat after ischemia-reperfusion injury. Biomedical journal 2023. link 6 Palmier M, Cornet E, Renet S, Dumesnil A, Perzo N, Cohen Q et al.. A Supraceliac Aortic Cross Clamping Model to Explore Remote Lung Injury and the Endothelial Glycocalyx. Annals of vascular surgery 2023. link 7 Yan R, Gao W, Chen W, Liu Y, Shen L, Dai Y et al.. rTFPI Protects Cardiomyocytes from Hypoxia/Reoxygenation Injury through Inhibiting Autophagy and the Class III PI3K/Beclin-1 Pathway. Cell biochemistry and biophysics 2023. link 8 Lu H, Zhang J, Xuan F. MiR-7a-5p Attenuates Hypoxia/Reoxygenation-Induced Cardiomyocyte Apoptosis by Targeting VDAC1. Cardiovascular toxicology 2022. link 9 Panda V, Bhandare N, Mistry K, S S, Dande P. Cardioprotective potential of . Archives of physiology and biochemistry 2022. link 10 Ozkaya E, Taskent I, Somay R, Ocal G, Heybeli C. Acute ischemic events after COVID-19 infection in patients undergoing maintenance hemodialysis. Hemodialysis international. International Symposium on Home Hemodialysis 2022. link 11 Padmavathi G, Ramkumar KM. MicroRNA mediated regulation of the major redox homeostasis switch, Nrf2, and its impact on oxidative stress-induced ischemic/reperfusion injury. Archives of biochemistry and biophysics 2021. link 12 Tibenska V, Marvanova A, Elsnicova B, Hejnova L, Vebr P, Novotný J et al.. The cardioprotective effect persisting during recovery from cold acclimation is mediated by the β. Journal of applied physiology (Bethesda, Md. : 1985) 2021. link 13 Li W, Sun K, Hu F, Chen L, Zhang X, Wang F et al.. Protective effects of natural compounds against oxidative stress in ischemic diseases and cancers via activating the Nrf2 signaling pathway: A mini review. Journal of biochemical and molecular toxicology 2021. link 14 He Y, Wang G, Gao H, Liu Y, Li H, Feng Y et al.. Prolonged duration of repolarization and decreased conduction velocity in the atrial myocardium after hypothermic ischemia-reperfusion may be related to expressions of inward rectifier potassium channel 2.1 protein and connexin 40. Perfusion 2021. link 15 Jäger B, Vargas KG, Haller PM, Stojkovic S, Kaufmann CC, Freynhofer M et al.. Immature cell fractions after cessation of chronic P2Y. Platelets 2021. link 16 Tu CC, Wan BY, Zeng Y. STIM2 knockdown protects against ischemia/reperfusion injury through reducing mitochondrial calcium overload and preserving mitochondrial function. Life sciences 2020. link 17 Liatis T, Furtado AR, Mantis P, Cherubini GB. Convergence-Retraction Nystagmus in a Dog With Presumptive Ischemic Encephalopathy Following Acute Cervicothoracic Myelopathy. Topics in companion animal medicine 2020. link 18 Chueh TH, Cheng YH, Chen KH, Chien CT. Thromboxane A2 Synthase and Thromboxane Receptor Deletion Reduces Ischaemia/Reperfusion-Evoked Inflammation, Apoptosis, Autophagy and Pyroptosis. Thrombosis and haemostasis 2020. link 19 Mo XY, Li XM, She CS, Lu XQ, Xiao CG, Wang SH et al.. Hydrogen-rich saline protects rat from oxygen glucose deprivation and reperusion-induced apoptosis through VDAC1 via Bcl-2. Brain research 2019. link 20 Wang W, Zheng Y, Wang M, Yan M, Jiang J, Li Z. Exosomes derived miR-126 attenuates oxidative stress and apoptosis from ischemia and reperfusion injury by targeting ERRFI1. Gene 2019. link 21 Dai JC, Ahn JS, Cannon ST, Walsh TJ, Ostrowski K, Raheem OA et al.. Acute Ischemic Priapism Management: An Educational and Simulation Curriculum. MedEdPORTAL : the journal of teaching and learning resources 2018. link 22 Thomas DD, Corey C, Hickok J, Wang Y, Shiva S. Differential mitochondrial dinitrosyliron complex formation by nitrite and nitric oxide. Redox biology 2018. link 23 Herr DJ, Baarine M, Aune SE, Li X, Ball LE, Lemasters JJ et al.. HDAC1 localizes to the mitochondria of cardiac myocytes and contributes to early cardiac reperfusion injury. Journal of molecular and cellular cardiology 2018. link 24 Zhang Y, Li XR, Zhao L, Duan GL, Xiao L, Chen HP. DJ-1 preserving mitochondrial complex I activity plays a critical role in resveratrol-mediated cardioprotection against hypoxia/reoxygenation-induced oxidative stress. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 2018. link 25 Han X, Wang R, Song X, Yu F, Lv C, Chen L. A mitochondrial-targeting near-infrared fluorescent probe for bioimaging and evaluating endogenous superoxide anion changes during ischemia/reperfusion injury. Biomaterials 2018. link 26 Folino A, Accomasso L, Giachino C, Montarolo PG, Losano G, Pagliaro P et al.. Apelin-induced cardioprotection against ischaemia/reperfusion injury: roles of epidermal growth factor and Src. Acta physiologica (Oxford, England) 2018. link 27 Korthuis RJ. Mechanisms of I/R-Induced Endothelium-Dependent Vasodilator Dysfunction. Advances in pharmacology (San Diego, Calif.) 2018. link 28 Tsou LK, Huang YH, Song JS, Ke YY, Huang JK, Shia KS. Harnessing CXCR4 antagonists in stem cell mobilization, HIV infection, ischemic diseases, and oncology. Medicinal research reviews 2018. link 29 Behmenburg F, Trefz L, Dorsch M, Ströthoff M, Mathes A, Raupach A et al.. Milrinone-Induced Postconditioning Requires Activation of Mitochondrial Ca. Journal of cardiothoracic and vascular anesthesia 2018. link 30 Bliksøen M, Rutkovskiy A, Vaage J, Stensløkken KO. Mode of perfusion influences infarct size, coronary flow and stress kinases in the isolated mouse heart. Acta physiologica (Oxford, England) 2017. link 31 Lee KH, Ha SJ, Woo JS, Lee GJ, Lee SR, Kim JW et al.. Exenatide Prevents Morphological and Structural Changes of Mitochondria Following Ischaemia-Reperfusion Injury. Heart, lung & circulation 2017. link 32 Nelson JA, Chung CU, Bauder AR, Wu LC. Prevention of thrombosis in hypercoagulable patients undergoing microsurgery: A novel anticoagulation protocol. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2017. link 33 Zhang RQ, Li DY, Xu TD, Zhu SS, Pan HJ, Fang F et al.. Antioxidative effect of luteolin pretreatment on simulated ischemia/reperfusion injury in cardiomyocyte and perfused rat heart. Chinese journal of integrative medicine 2017. link 34 Cheng Y, Xiong J, Chen Q, Xia J, Zhang Y, Yang X et al.. Hypoxia/reoxygenation-induced HMGB1 translocation and release promotes islet proinflammatory cytokine production and early islet graft failure through TLRs signaling. Biochimica et biophysica acta. Molecular basis of disease 2017. link 35 Mongardon N, Kohlhauer M, Lidouren F, Hauet T, Giraud S, Hutin A et al.. A Brief Period of Hypothermia Induced by Total Liquid Ventilation Decreases End-Organ Damage and Multiorgan Failure Induced by Aortic Cross-Clamping. Anesthesia and analgesia 2016. link 36 Heyman SN, Leibowitz D, Mor-Yosef Levi I, Liberman A, Eisenkraft A, Alcalai R et al.. Adaptive response to hypoxia and remote ischaemia pre-conditioning: a new hypoxia-inducible factors era in clinical medicine. Acta physiologica (Oxford, England) 2016. link 37 Yao YT, Liu DH, Li LH. Comparison of cardio-protective effects induced by different modalities of sevoflurane conditioning in isolated rat hearts. Perfusion 2016. link 38 Xue R, Wu G, Wei X, Lv J, Fu R, Lei X et al.. Tea polyphenols may attenuate the neurocognitive impairment caused by global cerebral ischemia/reperfusion injury via anti-apoptosis. Nutritional neuroscience 2016. link 39 Gottlieb RA, Pourpirali S. Lost in translation: miRNAs and mRNAs in ischemic preconditioning and ischemia/reperfusion injury. Journal of molecular and cellular cardiology 2016. link 40 Miller BA, Cheung JY. TRPM2 protects against tissue damage following oxidative stress and ischaemia-reperfusion. The Journal of physiology 2016. link 41 He H, Huh J, Wang H, Kang Y, Lou J, Xu Z. Mitochondrial events responsible for morphine's cardioprotection against ischemia/reperfusion injury. Toxicology and applied pharmacology 2016. link 42 Halestrap AP, Pereira GC, Pasdois P. The role of hexokinase in cardioprotection - mechanism and potential for translation. British journal of pharmacology 2015. link 43 Chen Y, Liu J, Zheng Y, Wang J, Wang Z, Gu S et al.. Uncoupling protein 3 mediates H₂O₂ preconditioning-afforded cardioprotection through the inhibition of MPTP opening. Cardiovascular research 2015. link 44 Kimura H. Signaling of hydrogen sulfide and polysulfides. Antioxidants & redox signaling 2015. link 45 Bone DB, Antic M, Quinonez D, Hammond JR. Hypoxanthine uptake by skeletal muscle microvascular endothelial cells from equilibrative nucleoside transporter 1 (ENT1)-null mice: effect of oxidative stress. Microvascular research 2015. link 46 Spanos E, Karlsson LO, Redfors B, Shao Y, Omerovic E, Bobrova I et al.. Cardioprotection of the enkephalin analog Eribis peptide 94 in a rat model of ischemia and reperfusion is highly dependent on dosing regimen and timing of administration. European journal of pharmacology 2015. link 47 Mangano GR, Turriziani P, Bonnì S, Caltagirone C, Oliveri M. Processing past tense in the left cerebellum. Neurocase 2015. link 48 Randhawa PK, Bali A, Jaggi AS. RIPC for multiorgan salvage in clinical settings: evolution of concept, evidences and mechanisms. European journal of pharmacology 2015. link 49 Pac-Soo CK, Mathew H, Ma D. Ischaemic conditioning strategies reduce ischaemia/reperfusion-induced organ injury. British journal of anaesthesia 2015. link 50 Hernández-Esquivel L, Pavón N, Buelna-Chontal M, González-Pacheco H, Belmont J, Chávez E. Citicoline (CDP-choline) protects myocardium from ischemia/reperfusion injury via inhibiting mitochondrial permeability transition. Life sciences 2014. link 51 Sari AN, Kacan M, Unsal D, Sahan Firat S, Kemal Buharalioglu C, Vezir O et al.. Contribution of RhoA/Rho-kinase/MEK1/ERK1/2/iNOS pathway to ischemia/reperfusion-induced oxidative/nitrosative stress and inflammation leading to distant and target organ injury in rats. European journal of pharmacology 2014. link 52 Chen Y, Lee SH, Tsai YH, Tseng SH. Ischemic preconditioning increased the intestinal stem cell activities in the intestinal crypts in mice. The Journal of surgical research 2014. link 53 Singh KK, Yanagawa B, Quan A, Wang R, Garg A, Khan R et al.. Autophagy gene fingerprint in human ischemia and reperfusion. The Journal of thoracic and cardiovascular surgery 2014. link 54 Liu CL, He YY, Li X, Li RJ, He KL, Wang LL. Inhibition of serine/threonine protein phosphatase PP1 protects cardiomyocytes from tunicamycin-induced apoptosis and I/R through the upregulation of p-eIF2α. International journal of molecular medicine 2014. link 55 Csonka C, Kupai K, Bencsik P, Görbe A, Pálóczi J, Zvara A et al.. Cholesterol-enriched diet inhibits cardioprotection by ATP-sensitive K+ channel activators cromakalim and diazoxide. American journal of physiology. Heart and circulatory physiology 2014. link 56 Rosero O, Németh K, Turóczi Z, Fülöp A, Garbaisz D, Győrffy A et al.. Collateral circulation of the rat lower limb and its significance in ischemia-reperfusion studies. Surgery today 2014. link 57 Guillot M, Charles AL, Chamaraux-Tran TN, Bouitbir J, Meyer A, Zoll J et al.. Oxidative stress precedes skeletal muscle mitochondrial dysfunction during experimental aortic cross-clamping but is not associated with early lung, heart, brain, liver, or kidney mitochondrial impairment. Journal of vascular surgery 2014. link 58 Li Q, Liu Y, Jiao J, Zhang C, Lou J. Assessment of effects of IR and IPC on activities of cytochrome P450 isozymes in rats by a five-drug cocktail approach. Drug development and industrial pharmacy 2014. link 59 Andres AM, Hernandez G, Lee P, Huang C, Ratliff EP, Sin J et al.. Mitophagy is required for acute cardioprotection by simvastatin. Antioxidants & redox signaling 2014. link 60 Schaffer SW, Jong CJ, Ito T, Azuma J. Effect of taurine on ischemia-reperfusion injury. Amino acids 2014. link 61 Thornsberry LA, LoSicco KI, English JC. The skin and hypercoagulable states. Journal of the American Academy of Dermatology 2013. link 62 Han JK, Kim HL, Jeon KH, Choi YE, Lee HS, Kwon YW et al.. Peroxisome proliferator-activated receptor-δ activates endothelial progenitor cells to induce angio-myogenesis through matrix metallo-proteinase-9-mediated insulin-like growth factor-1 paracrine networks. European heart journal 2013. link 63 Wegiel B, Hanto DW, Otterbein LE. The social network of carbon monoxide in medicine. Trends in molecular medicine 2013. link 64 Chambers JW, Pachori A, Howard S, Iqbal S, LoGrasso PV. Inhibition of JNK mitochondrial localization and signaling is protective against ischemia/reperfusion injury in rats. The Journal of biological chemistry 2013. link 65 Stowe DF, Gadicherla AK, Zhou Y, Aldakkak M, Cheng Q, Kwok WM et al.. Protection against cardiac injury by small Ca(2+)-sensitive K(+) channels identified in guinea pig cardiac inner mitochondrial membrane. Biochimica et biophysica acta 2013. link 66 Queliconi BB, Marazzi TB, Vaz SM, Brookes PS, Nehrke K, Augusto O et al.. Bicarbonate modulates oxidative and functional damage in ischemia-reperfusion. Free radical biology & medicine 2013. link 67 Bahjat FR, Gesuete R, Stenzel-Poore MP. Steps to translate preconditioning from basic research to the clinic. Translational stroke research 2013. link 68 Brosková Z, Drábiková K, Sotníková R, Fialová S, Knezl V. Effect of plant polyphenols on ischemia-reperfusion injury of the isolated rat heart and vessels. Phytotherapy research : PTR 2013. link 69 Liepinsh E, Kuka J, Dambrova M. Troubleshooting digital macro photography for image acquisition and the analysis of biological samples. Journal of pharmacological and toxicological methods 2013. link 70 Wu H, Lei S, Yuan J, Liu X, Zhang D, Gu X et al.. Ischemic postconditioning downregulates Egr-1 expression and attenuates postischemic pulmonary inflammatory cytokine release and tissue injury in rats. The Journal of surgical research 2013. link 71 Donato M, Buchholz B, Rodríguez M, Pérez V, Inserte J, García-Dorado D et al.. Role of the parasympathetic nervous system in cardioprotection by remote hindlimb ischaemic preconditioning. Experimental physiology 2013. link 72 He X, Zhao M, Bi XY, Yu XJ, Zang WJ. Delayed preconditioning prevents ischemia/reperfusion-induced endothelial injury in rats: role of ROS and eNOS. Laboratory investigation; a journal of technical methods and pathology 2013. link 73 Liang H, Yu F, Tong Z, Yuan B, Wang C. Effect of ischemia post-conditioning on skeletal muscle oxidative injury, mTOR, Bax, Bcl-2 proteins expression, and HIF-1α/β-actin mRNA, IL-6/β-actin mRNA and caveolin-3/β-actin mRNA expression in ischemia-reperfusion rabbits. Molecular biology reports 2013. link 74 Yang XH, Wang YH, Wang JJ, Liu YC, Deng W, Qin C et al.. Role of angiotensin-converting enzyme (ACE and ACE2) imbalance on tourniquet-induced remote kidney injury in a mouse hindlimb ischemia-reperfusion model. Peptides 2012. link 75 Miura T, Tanno M. The mPTP and its regulatory proteins: final common targets of signalling pathways for protection against necrosis. Cardiovascular research 2012. link 76 Pedersen CM, Barnes G, Schmidt MR, Bøtker HE, Kharbanda RK, Newby DE et al.. Ischaemia-reperfusion injury impairs tissue plasminogen activator release in man. European heart journal 2012. link 77 Wouters CW, Meijer P, Janssen CI, Frederix GW, Oyen WJ, Boerman OC et al.. Atorvastatin does not affect ischaemia-induced phosphatidylserine exposition in humans in-vivo. Journal of atherosclerosis and thrombosis 2012. link 78 Lu G, Ashraf M, Haider KH. Insulin-like growth factor-1 preconditioning accentuates intrinsic survival mechanism in stem cells to resist ischemic injury by orchestrating protein kinase cα-erk1/2 activation. Antioxidants & redox signaling 2012. link 79 Kuka J, Vilskersts R, Cirule H, Makrecka M, Pugovics O, Kalvinsh I et al.. The cardioprotective effect of mildronate is diminished after co-treatment with L-carnitine. Journal of cardiovascular pharmacology and therapeutics 2012. link 80 Agarwal B, Camara AK, Stowe DF, Bosnjak ZJ, Dash RK. Enhanced charge-independent mitochondrial free Ca(2+) and attenuated ADP-induced NADH oxidation by isoflurane: Implications for cardioprotection. Biochimica et biophysica acta 2012. link 81 Onegbu N, Kamran H, Sharma B, Bapat M, Littman S, Warrier N et al.. The effects of ischemia with and without remote conditioning on hyperemia induced decline in carotid-radial pulse wave velocity. Atherosclerosis 2012. link 82 Palee S, Weerateerangkul P, Surinkeaw S, Chattipakorn S, Chattipakorn N. Effect of rosiglitazone on cardiac electrophysiology, infarct size and mitochondrial function in ischaemia and reperfusion of swine and rat heart. Experimental physiology 2011. link 83 Gyurkovics E, Aranyi P, Stangl R, Onody P, Ferreira G, Lotz G et al.. Postconditioning of the lower limb--protection against the reperfusion syndrome. 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Cardiovascular research 2011. link 93 Han F, Tao RR, Zhang GS, Lu YM, Liu LL, Chen YX et al.. Melatonin ameliorates ischemic-like injury-evoked nitrosative stress: Involvement of HtrA2/PED pathways in endothelial cells. Journal of pineal research 2011. link 94 Zhang H, Wang ZQ, Zhao DY, Zheng DM, Feng J, Song LC et al.. AIF-mediated mitochondrial pathway is critical for the protective effect of diazoxide against SH-SY5Y cell apoptosis. Brain research 2011. link 95 Voelkl JG, Haubner BJ, Kremser C, Mayr A, Klug G, Loizides A et al.. Cardiac imaging using clinical 1.5 t MRI scanners in a murine ischemia/reperfusion model. Journal of biomedicine & biotechnology 2011. link 96 Pontell L, Sharma P, Rivera LR, Thacker M, Tan YH, Brock JA et al.. Damaging effects of ischemia/reperfusion on intestinal muscle. Cell and tissue research 2011. link 97 Nakamori Y, Komatsu Y, Kotani T, Kojima S, Takeuchi K. 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    Original source

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      rTFPI Protects Cardiomyocytes from Hypoxia/Reoxygenation Injury through Inhibiting Autophagy and the Class III PI3K/Beclin-1 Pathway.Yan R, Gao W, Chen W, Liu Y, Shen L, Dai Y et al. Cell biochemistry and biophysics (2023)
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