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Frontiers in Neuroscience 2022Cerebral vasospasm is a frequently encountered clinical problem, especially in patients with traumatic brain injury and subarachnoid hemorrhage. Continued cerebral... (Review)
Review
Cerebral vasospasm is a frequently encountered clinical problem, especially in patients with traumatic brain injury and subarachnoid hemorrhage. Continued cerebral vasospasm can cause cerebral ischemia, even infarction and delayed ischemic neurologic deficits. It significantly affects the course of the disease and the outcome of the patient. However, the underlying mechanism of cerebral vasospasm is still unclear. Recently, increasing studies focus on the pathogenic mechanism of microparticles. It has been found that microparticles have a non-negligible role in promoting vasospasm. This research aims to summarize the dynamics of microparticles and identify a causal role of microparticles in the occurrence and development of cerebral vasospasm. We found that these various microparticles showed dynamic characteristics in body fluids and directly or indirectly affect the cerebral vasospasm or prompt it. Due to the different materials carried by microparticles from different cells, there are also differences in the mechanisms that lead to abnormal vasomotor. We suggest that microparticle scavengers might be a promising therapeutic target against microparticles associated complications.
PubMed: 36389239
DOI: 10.3389/fnins.2022.1013437 -
Frontiers in Neurology 2014Vasospasm has been a long known source of delayed morbidity and mortality in aneurysmal subarachnoid hemorrhage patients. Delayed ischemic neurologic deficits associated... (Review)
Review
Vasospasm has been a long known source of delayed morbidity and mortality in aneurysmal subarachnoid hemorrhage patients. Delayed ischemic neurologic deficits associated with vasospasm may account for as high as 50% of the deaths in patients who survive the initial period after aneurysm rupture and its treatment. The diagnosis and treatment of vasospasm has still been met with some controversy. It is clear that subarachnoid hemorrhage is best cared for in tertiary care centers with modern resources and access to cerebral angiography. Ultimately, a high degree of suspicion for vasospasm must be kept during ICU care, and any signs or symptoms must be investigated and treated immediately to avoid permanent stroke and neurologic deficit. Treatment for vasospasm can occur through both ICU intervention and endovascular administration of intra-arterial vasodilators and balloon angioplasty. The best outcomes are often attained when these methods are used in conjunction. The following article reviews the literature on cerebral vasospasm and its treatment and provides the authors' approach to treatment of these patients.
PubMed: 24904517
DOI: 10.3389/fneur.2014.00072 -
Journal of Medicine and Life Jun 2013Subarachnoid hemorrhage represents a serious disease with high mortality and morbidity. Two important areas are becoming the central research interest of subarachnoid... (Review)
Review
Subarachnoid hemorrhage represents a serious disease with high mortality and morbidity. Two important areas are becoming the central research interest of subarachnoid hemorrhage: cerebral vasospasm and early brain injury. The authors have reviewed the major contributions in experimental subarachnoid hemorrhage documented in the medical literature in the past 5 years. Treatments interfering with nitric oxide - or endothelin-pathways continue to show antispasmotic effects in experimental models of subarachnoid hemorrhage. Inflammation and oxidative stress play a vital role in the pathophysiology of cerebral vasospasm. Apoptosis, a relevant cause of early brain injury after subarachnoid hemorrhage, also underline the etiology of cerebral vasospasm. Future research studies will continue to elucidate the pathophysiological pathways and treatment modalities targeting cerebral vasospasm and early brain injury, enabling an improvement in outcome for patients with subarachnoid hemorrhage.
Topics: Apoptosis; Humans; Hypoxia-Inducible Factor 1; Nitrous Oxide; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 23904869
DOI: No ID Found -
Current Neurology and Neuroscience... 2015Vasospasm and delayed cerebral ischemia remain to be the common causes of increased morbidity and mortality after aneurysmal subarachnoid hemorrhage. The majority of... (Review)
Review
Vasospasm and delayed cerebral ischemia remain to be the common causes of increased morbidity and mortality after aneurysmal subarachnoid hemorrhage. The majority of clinical vasospasm responds to hemodynamic augmentation and direct vascular intervention; however, a percentage of patients continue to have symptoms and neurological decline. Despite suboptimal evidence, clinicians have several options in treating refractory vasospasm in aneurysmal subarachnoid hemorrhage (aSAH), including cerebral blood flow enhancement, intra-arterial manipulations, and intra-arterial and intrathecal infusions. This review addresses standard treatments as well as emerging novel therapies aimed at improving cerebral perfusion and ameliorating the neurologic deterioration associated with vasospasm and delayed cerebral ischemia.
Topics: Angioplasty; Cerebral Angiography; Humans; Hypothermia, Induced; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 25501582
DOI: 10.1007/s11910-014-0521-1 -
The New England Journal of Medicine Jun 2017
Topics: Chest Pain; Coronary Angiography; Coronary Vasospasm; Humans; Male; Middle Aged; Nitroglycerin
PubMed: 28636863
DOI: 10.1056/NEJMicm1614640 -
Acta Neurochirurgica Nov 2023Pleiotropic effects of statins may be beneficial in alleviating cerebral vasospasm (VS) and improving outcome after aneurysmal subarachnoid hemorrhage (aSAH). Initiation...
BACKGROUND
Pleiotropic effects of statins may be beneficial in alleviating cerebral vasospasm (VS) and improving outcome after aneurysmal subarachnoid hemorrhage (aSAH). Initiation of statin treatment at aSAH is not recommended; however, the effect of pre-ictal and continued statin use is not fully investigated.
METHODS
Retrospective study comparing aSAH patients admitted in 2012 to 2021 with pre-ictal statin use versus those not using statins. Patient entry variables, radiological/sonological VS, symptomatic VS, and radiologically documented delayed cerebral ischemia (DCI) were registered. Outcome was scored in terms of mortality, modified Rankin score, Glasgow outcome score extended, and levels of fatigue. Patients were compared on group level and in a case-control design.
RESULTS
We included 961 patients, with 204 (21.2%) statin users. Statin users were older and had more often hypertension. Severe radiological/sonological VS, symptomatic VS, and DCI were less frequent in statin users, and their length of stay was shorter. Mortality, functional outcome, and levels of fatigue were similar in both groups. When analyzing 89 pairs of statin users and non-statin users matched for age, aSAH severity, gender, and hypertension, we confirmed decreased radiological/sonological and symptomatic VS as well as shorter length of stay in statin users. They also had more often a favorable functional outcome and lower levels of fatigue.
CONCLUSIONS
Patients with pre-ictal and continued use of statins have a reduced occurrence of radiological/sonological and symptomatic VS, shorter length of stay, and more often favorable functional outcome, whereas mortality is similar to non-statin users. Even though larger multicenter studies with common, strict protocols for prevention, diagnosis, and treatment of vasospasm are needed to finally establish the value of statins in aSAH, continuation of pre-ictal statin use seems worthwhile.
Topics: Humans; Subarachnoid Hemorrhage; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Retrospective Studies; Cerebral Infarction; Brain Ischemia; Vasospasm, Intracranial; Hypertension
PubMed: 37792050
DOI: 10.1007/s00701-023-05812-2 -
BioMed Research International 2014Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid... (Review)
Review
Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed.
Topics: Brain Ischemia; Humans; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 24967389
DOI: 10.1155/2014/628597 -
Cerebrovascular Diseases (Basel,... 2016Cerebral vasospasm and sodium and fluid imbalances are common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and cause of significant morbidity and mortality.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cerebral vasospasm and sodium and fluid imbalances are common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and cause of significant morbidity and mortality. Studies have shown the benefit of corticosteroids in the management of these sequelae. We have reviewed the literature and analyzed the available data for corticosteroid use after SAH.
METHODS
PubMed, EMBASE, and Cochrane electronic databases were searched without language restrictions, and 7 observational, controlled clinical studies of the effect of corticosteroids in the management of SAH patients were identified. Data on sodium and fluid balances, symptomatic vasospasm (SVS), and outcomes were pooled for meta-analyses using the Mantel-Haenszel random effects model.
RESULTS
Corticosteroids, specifically hydrocortisone and fludrocortisone, decreased natriuretic diuresis and incidence of hypovolemia. Corticosteroid administration is associated with lower incidence of SVS in the absence of nimodipine, but does not alter the neurological outcome.
CONCLUSIONS
Supplementation of corticosteroids with mineralocorticoid activity, such as hydrocortisone or fludrocortisone, helps in maintaining sodium and volume homeostasis in SAH patients. Larger trials are warranted to confirm the effects of corticosteroids on SVS and patient outcomes.
Topics: Adrenal Cortex Hormones; Cerebral Arteries; Chi-Square Distribution; Fludrocortisone; Humans; Hydrocortisone; Hyponatremia; Hypovolemia; Natriuresis; Odds Ratio; Sodium; Subarachnoid Hemorrhage; Treatment Outcome; Vasoconstriction; Vasospasm, Intracranial; Water-Electrolyte Balance
PubMed: 27173669
DOI: 10.1159/000446251 -
BioMed Research International 2014
Topics: Apoptosis; Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 25276807
DOI: 10.1155/2014/679014 -
Journal of Anaesthesiology, Clinical... 2019Cerebral vasospasm leading to delayed cerebral ischaemia is one of the major concerns following subarachnoid haemorrhage (SAH). Various modalities are present for... (Review)
Review
Cerebral vasospasm leading to delayed cerebral ischaemia is one of the major concerns following subarachnoid haemorrhage (SAH). Various modalities are present for evaluation and detection of cerebral vasospasm that occurs following SAH. They include transcranial Doppler (TCD), computed tomographic angiography (CTA), computed tomographic (CT) perfusion and digital subtraction angiography (DSA). The recent guidelines have advocated the use of TCD and have described it as a reasonable technique for monitoring the development of vasospasm. This review describes the functioning of TCD, the cerebral haemodynamic changes during vasospasm and TCD-based detection of vasospasm. The review shall highlight as to how the TCD derived values are relevant in the settings of neurocritical care. The data in the review have been consolidated based on our search of literature from year 1981 till 2016 using various data base.
PubMed: 31057233
DOI: 10.4103/joacp.JOACP_192_17