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What is the Ischemic Cascade?

Mary McMahon
Updated Mar 03, 2024
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The ischemic cascade is a series of events that occur on a cellular level in the brain when the supply of oxygen is interrupted. It begins within seconds of an ischemic event like a stroke that blocks the flow of blood to an area of the brain and can continue even after the normal flow of blood is restored. Because the cascade features a series of events taking place in a particular order, researchers have theorized that interventions could be possible during an ischemic event to halt the cascade and limit damage to the neurons in the brain.

When the supply of oxygen is cut off, cells cannot produce ATP for energy and they switch to an anaerobic method for metabolism. This causes a series of events as the cellular calcium levels rise, the cell releases amino acids to correct them, the calcium levels continue to peak, the cell wall breaks down, and the organelles in the cell start to die. This causes the cell itself to die and when it does, it releases toxins into the surrounding area, damaging neighboring cells, including cells with an adequate supply of oxygen.

As the ischemic cascade continues and neurons die, the patient can start to experience neurological symptoms because the brain is no longer able to function normally. In addition, swelling in the brain can develop, putting pressure on the brain and creating the potential for further medical complications. If the pressure is not relieved, the damage can spread to other areas of the brain and the ischemic cascade can have far reaching consequences.

The ischemic cascade unfurls when people have strokes, heart attacks, respiratory arrests, and other medical emergencies that limit the supply of oxygen to the brain. Neurologists have studied the process extensively to learn how it happens and what is involved in each stage, with the goal of potentially developing treatments to arrest the cascade. Researchers believe that halting the series of chemical reactions involved could derail the ischemic cascade, limiting damage to the neurons in the brain and reducing the risk that strokes and other events will have long-term consequences.

An important facet of the ischemic cascade is the risk that it will continue to happen even after the supply of oxygen is restored. The dead and dying cells in the brain will continue to release toxins once they reach a point of no return. Patients who experience ischemic events must be monitored closely for signs of complications suggestive of additional brain damage.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Mary McMahon
By Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a The Health Board researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

Discussion Comments
By anon323977 — On Mar 07, 2013

Strokes, mini strokes etc. do not come out of nowhere. They have a beginning like anything else in nature. On march 6, mount Etna erupted suddenly "out of nowhere" so to speak. This of course is nonsense. We expected it to erupt. A stroke is the same. However, the research is poised to solve it only after it has occurred. The precursor metabolic events for stroke are the same as for virtually every chronic degenerative disease known to man.

By hamje32 — On Nov 15, 2011

@MrMoody - What you’re describing is similar to a brain aneurism. Of course that’s a stroke for the brain so it would make sense that the symptoms are almost the same.

I had a friend, back in college, who got hit with an aneurism right out of nowhere. He lost his balance and his speech started slurring. Someone nearby, who knew the symptoms, immediately rushed him to the hospital before the cascade of events could complete.

I think the guy saved my friend’s life. I believe that early intervention is indeed the key.

By MrMoody — On Nov 14, 2011

On the local radio station I’ve been hearing public service announcements run on the dangers of an ischemic stroke. According to the commercial this is called a “mini stroke.”

The symptoms of TIA (transient ischemic stroke) are comparable to those of a regular stroke, including chest pain, sudden numbness in your body, difficulty speaking or a severe headache that hits you out of nowhere.

These symptoms come and go quickly, but they should be heeded as warning signs. It’s something I’m trying to become aware of because my dad had a stroke and it came quite suddenly.

I am changing my diet and exercising and hoping to become aware of these things so that I can preempt the problem before it occurs.

Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a...

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