In response to acute ischemic stroke, large numbers of bone marrow stem cells mobilize spontaneously in peripheral blood that home onto the site of ischemia activating the penumbra. But with chronicity, the numbers of mobilized cells decrease, reducing the degree and rate of recovery. Cellular therapy has been explored as a new avenue to restore the repair process in the chronic stage. A 67-year-old Indian male with a chronic right middle cerebral artery ischemic stroke had residual left hemiparesis despite standard management. Recovery was slow and partial resulting in dependence to carry out activities of daily living. Our aim was to enhance the speed of recovery process by providing an increased number of stem cells to the site of injury. We administered autologous bone marrow mononuclear cells intrathecally alongwith rehabilitation and regular follow up. The striking fact was that the hand functions, which are the most challenging deficits, showed significant recovery. Functional Independence Measure scores and quality of life improved. This could be attributed to the neural tissue restoration. We hypothesize that cell therapy may be safe, novel and appealing treatment for chronic ischemic stroke. Further controlled trials are indicated to advance the concept of Neurorestoration. 1. Introduction A stroke or cerebrovascular accident (CVA) is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain tissue. It may be classified as ischemic (thrombotic or embolic) or hemorrhagic [1]. The clinical presentation corresponds to the area of brain damage. Ischemic stroke results from a loss of blood supply to a part of the brain, initiating the ischemic cascade [1, 2]. Brain tissue ceases to function if deprived of oxygen for more than 60 to 90 seconds which after approximately two to four hours leads to irreversible injury and infarction. The core area of infarction is called the “umbra” and the surrounding partially viable neuronal cortex is referred to as the “ischemic penumbra” [1, 2]. The mainstay in the management of ischemic stroke is early restoration of blood supply to the affected brain areas. This includes thrombolysis with agents such as tissue plasminogen activator (tPA), streptokinase, urokinase, and others [3]. These are effective modalities with limitations such as a short window period (three hours) for administration, narrow indications, contraindications, and complications. Despite early restitution, residual sensorimotor and cognitive-perceptual deficits are commonly seen which require rehabilitative
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