Intracranial Vasospasm Research Articles

Transcranial Doppler Comparison of Balloon Angioplasty and Papaverine Infusion for the Treatment of Intracranial Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Introduction: We employed daily transcranial Doppler (TCD) evaluation following subarachnoid hemorrhage (SAH) to assess the relative success of balloon angioplasty (BA) and papaverine infusion (PI) with respect to permanent reversal of proximal arterial vasospasm (VSP) associated with delayed ischemic deficits. Methods: In patients treated between 1989 and 1995, TCD blood velocities of the involved distal ICA or proximal MCA were assessed in relation to the day of treatment with BA and or PI. Immediate pre-treatment velocity was compared to the velocity at 24 and 48 hours post-treatment for each vessel using the one-tailed paired-samples T Test. Vessels treated simultaneously with BA and PI were excluded. Vessels treated successively with PI and BA, or with repeated BA or PI, were included in the original treatment cohort until the day of the subsequent treatment. Results: Overall, 211 vessels segments were treated in 83 patients; the present study concerns 102 vessel segments treated...

Transcranial Doppler Comparison of Balloon Angioplasty and Papaverine Infusion for the Treatment of Intracranial Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Paper #712

Transcranial Doppler Comparison of Balloon Angioplasty and Papaverine Infusion for the Treatment of Intracranial Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Paper #712

Fatal cerebellar infarction in a migraine sufferer whilst receiving sumatriptan

This is a case report of a 39-year-old man who suffered from a fatal cerebellar infarction whilst on sumatriptan therapy for an acute attack of migraine. Intracranial vasospasm is proposed as the likely causative mechanism and possible therapeutic intervention is highlighted.

Interventional neurovascular techniques for cerebral revascularization in the treatment of stroke.

Recent advances in interventional neurovascular radiology have altered the management of cerebrovascular diseases by providing alternative treatments in three areas. (1) Cerebral percutaneous transluminal angioplasty is being used more often as an alternative to surgical endarterectomy or bypass grafting for patients with high-grade vascular stenosis of the innominate, subclavian, carotid, vertebral, and intracranial blood vessels. To date, the success rate has been greater than 90%, with less than 10% morbidity. (2) Transluminal angioplasty and local infusion of antispasmodic drugs are being used to treat patients with severe angiographic vasospasm unresponsive to conventional medical therapy. Intracranial arterial vasospasm due to subarachnoid hemorrhage has remained a leading cause of delayed morbidity and mortality. Neurologic improvement, defined as improvement in the Hunt and Hess neurologic grading scale, has been shown in 60-80% of the patients so treated. (3) Local intraarterial fibrinolysis has been beneficial for patients with acute thromboembolic occlusion in both intracranial arteries and the cerebral dural sinuses. Preliminary studies indicate that early revascularization is associated with improved neurologic outcome. This review delineates the current state of the art in interventional neurovascular techniques for treating patients with stroke in evolution and patients with signs and symptoms of impending stroke due to vascular stenosis or occlusion. These techniques for cerebral revascularization are under investigation as potential life-saving therapy when conventional medical or surgical treatment has failed. As more experience is gained, the results of controlled clinical trials become available, and technical improvements evolve, these procedures will decrease the morbidity and mortality associated with strokes.

Single‐Photon Emission Computed Tomography, Transcranial Doppler Ultrasound, and Cerebral Angioplasty for Posttraumatic Vasospasm

Intracranial arterial vasospasm is an important consequence of subarachnoid hemorrhage. In posttraumatic patients, this phenomenon is becoming increasingly recognized with noninvasive techniques that evaluate (1) vascular stenosis, such as transcranial Doppler (TCD) ultrasound, and (2) regional cerebral blood flow, such as single‐photon emission computed tomography (SPECT). A posttraumatic patient developed symptomatic vasospasm that was detected by TCD and SPECT and then treated with percutaneous transluminal balloon cerebral angioplasty, which improved the symptoms. The anatomical and functional results of angioplasty were evaluated also by TCD and SPECT, which showed a reduction in the severity of stenosis and improved blood flow, respectively.

Role of transcranial doppler in neuroradiological treatment of intracranial vasospasm.

Role of transcranial doppler in neuroradiological treatment of intracranial vasospasm.

Effects of Dobutamine and Dopamine on Whole Brain Blood Flow and Metabolism in Unanesthetized Monkeys

Dobutamine (DO) and dopamine (DA) are positive inotropic agents used clinically to improve cardiac output in patients in acute or chronic heart failure or to counteract intracranial vasospasm. These patients are also at risk for cerebrovascular disease, but studies on the effects of DA on cerebral blood flow (CBF) and metabolism are few and for DO nonexistent. We evaluated the effects on DO and DA on whole brain CBF and cerebral metabolic rates of oxygen (CMRO2) and glucose (CMRglc) in unanesthetized rhesus monkeys. Microelectrodes and catheters inserted in the superior sagittal sinus monitored H2 clearance and sampled cerebral venous blood. Studies were done at low and high doses with control measurements between doses. At 5.10, and 15 microg/kg/min (n = 6), neither systemic nor cerebral variables were affected by either drug. At doses of 50 and 100 microg/kg/min (n = 4), DO and DA increased arterial blood pressure and heart rate by 15 to 30%. Whereas CBF, CMRO2, and CMRglc were clearly unaffected by DO at high doses, they increased by 20-30% with DA, 100 microg/kg/min and although not significant (p >0.05), the consistency and magnitude of the increase along with the likelihood of a type II error led us to conclude that (a) both DO and DA are less effective in monkeys than in humans and (b) whereas DO at all doses tested showed no indication of affecting CBF and CMR, DA increased CBF and CMR by 20 to 30% at a dose of 100 microg/kg/min.

Transluminal Angioplasty for Treatment of Vasospasm

Angioplasty of symptomatic vasospasm can reverse neurologic deficits when performed soon after the onset of symptoms. Deficits including hemiparesis, aphasia, and depressed level of consciousness can resolve within 12 to 48 hours following angioplasty. Eleven of 15 patients had such a response in our series. All major intracranial vessels are amenable to treatment by this technique. Initial experience indicates the results are long lasting and the complication rate is low. This technique should prove to be a useful adjunct in the management of subarachnoid hemorrhage.

<I>Intracranial Arterial Vasospasm Associated with Pituitary Apoplexy after Head Trauma</I>

A case of intracranial arterial vasospasm caused by pituitary apoplexy after head trauma is reported. In this case, pituitary apoplexy was secondary to head trauma, and the vasospasm was thought to be due to subarachnoid hemorrhage from a pituitary tumor. No such case has previously been reported in the literature.

Transluminal angioplasty for treatment of intracranial arterial vasospasm

Percutaneous transluminal angioplasty for treatment of intracerebral arterial vasospasm is now being performed in selected cases. Thirty-six vascular territories in 13 patients, ranging in age from 15 to 73 years, have been treated with a new silicone microballoon device. This balloon has allowed mechanical dilatation of segmental and diffuse areas of spastic intracerebral blood vessels less than 1 mm in diameter with return to normal luminal diameter. Follow-up angiography has documented improved cerebral perfusion without return of spasm. In 10 patients (77%), vasospasm was due to subarachnoid hemorrhage following rupture of an intracranial aneurysm. In three patients (23%), spasm with resultant neurological decline occurred during detachable balloon embolization therapy for treatment of an aneurysm. In each case, the vessel caliber returned to normal size following balloon dilatation. In nine (69%) of the 13 cases, balloon dilatation resulted in improvement of neurological function within minutes to hours following the procedure. Transluminal angioplasty techniques may offer an alternative form of therapy in the management of symptomatic arterial vasospasm.

Prevention of Postoperative Intracranial Arterial Vasospasm by Ventriculo-cisternal Drainage in Patients with Ruptured Intracranial Aneurysms

Prevention of Postoperative Intracranial Arterial Vasospasm by Ventriculo-cisternal Drainage in Patients with Ruptured Intracranial Aneurysms

Perivascular action of the local anaesthetic, lidocaine, on pial terminal arterioles: direct observations on the microcirculation.

Considerable controversy currently exists with respect to whether or not local anaesthetics exert direct action on cerebral arteriolar tone. In situ experiments were therefore undertaken on pial terminal arterioles of rats to determine whether or not perivascular application of lidocaine exerts any action on such cerebral vessels. Vessel size was assessed with an image-splitting television microscope recording system. The vessels studied ranged in size from 25 to 30 micron. Lidocaine was applied in artificial CSF in dosages of 0.01, 0.1, 1.0 and 2.0 mg. Significant dose-dependent dilatation (i.e., 15.7-45.3% increases in lumen sizes) of the pial terminal arterioles was observed. The results are discussed in light of current developments concerning the mechanism whereby local anaesthetics alleviate increased intracranial pressure and cerebral vasospasm.