| Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 15472097 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Papaverine is used to vasodilate cerebral arteries undergoing vasospasm from subarachnoid hemorrhage. However, papaverine inhibits cellular respiration in vitro and could cause neurotoxicity in humans. METHODS: We studied 5 consecutive patients with cerebral vasospasm who were treated with intra-arterial papaverine preserved with chlorobutanol and imaged with MRI fluid-attenuated inversion recovery and diffusion-weighted imaging after treatment. One patient had histological analysis of the brain at autopsy. RESULTS: All 5 patients exhibited marked neurological decline immediately after treatment, and this was sustained through hospital discharge. In all cases, MRI images showed selective gray matter-only signal changes within the vascular territory treated with papaverine. Histological analysis of 1 case brought to autopsy showed selective injury to islands of neurons with relative sparing of white matter. CONCLUSIONS: Intra-arterial delivery of papaverine preserved with chlorobutanol into vasospastic anterior cerebral arteries may result in marked neurological deterioration with selective gray matter changes on MRI imaging. This effect is consistent with a permanent toxic effect to human brain. It is unclear whether this toxicity is caused by papaverine or chlorobutanol, and its use in the treatment of cerebral vasospasm should be reserved for cases without alternatives. |
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Authors:
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Wade S Smith; Christopher F Dowd; S Claiborne Johnston; Nerissa U Ko; Stephen J DeArmond; William P Dillon; Deepa Setty; Michael T Lawton; William L Young; Randall T Higashida; Van V Halbach |
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Publication Detail:
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Type: Journal Article Date: 2004-10-07 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 35 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-10-29 Completed Date: 2005-05-11 Revised Date: 2011-05-24 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 2518-22 Citation Subset: IM |
Affiliation:
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Department of Neurology, University of California, San Francisco, Calif 94134-0114, USA. wssmith@itsa.ucsf.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Brain / drug effects*, pathology Chlorobutanol / adverse effects Female Humans Infusions, Intra-Arterial Magnetic Resonance Imaging Male Middle Aged Papaverine / administration & dosage, adverse effects*, therapeutic use Preservatives, Pharmaceutical / adverse effects Retrospective Studies Subarachnoid Hemorrhage / complications, drug therapy* Vasodilator Agents / administration & dosage, adverse effects*, therapeutic use Vasospasm, Intracranial / drug therapy*, etiology |
| Grant Support | |
ID/Acronym/Agency:
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K23 NS044014-05/NS/NINDS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Preservatives, Pharmaceutical; 0/Vasodilator Agents; 57-15-8/Chlorobutanol; 58-74-2/Papaverine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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