Brain protection--human data and potential new therapies.

Neuroprotective therapy for acute ischemic stroke is the focus of considerable animal and human research. Several agents have progressed through human clinical trials and hold great promise both as single agents and adjuncts to thrombolytic therapy. Cytoprotective therapy is aimed at interfering with the ischemic cascade in penumbral tissue in regions of reduced cerebral blood flow. The ischemic cascade involves failure of adenosine triphosphate-driven ion pumps and consequent cell swelling and lactate accumulation. The cascade continues to involve excitatory amino acid-mediated injury which involves calcium dysregulation. Human studies which have progressed from previous animal work have focused on inhibiting excitatory amino acid-mediated injury, preventing free-radical effects, and blocking intracellular accumulation of calcium. The clinical use of these neuroprotective agents is definitely on the horizon, while active research continues.