| New concepts regarding cerebral vasospasm: glial-centric mechanisms. | |
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MedLine Citation:
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PMID: 20131107 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Poor outcome in patients with cerebral vasospasm following subarachnoid hemorrhage remains a serious clinical problem. The current management with focus on the cerebrovascular constriction accounts for the use of "triple-H" therapy (hypertension, hypervolemia, and hemodilution) to enhance cerebral blood flow through constricted vessels. Recent work suggests that spreading depression (a stereotypical response of cerebral cortical tissue to noxious stimuli with subsequent oligemic blood flow) occurs in patients with cerebral vasospasm. A narrative review was conducted to examine the relationship between spreading depression and subarachnoid hemorrhage and to identify the anesthetic effects on the propagation of spreading depression. PRINCIPAL FINDINGS: Following review of the literature, an underlying mechanism is advanced that cerebral vasospasm is not primarily a problem of the cerebral vasculature but a consequence of glial cell dysfunction following spreading depression - a glial-centric cause for vasospasm. Such a mechanism for vasospasm becomes manifest when spreading depression waves transition to peri-infarct depolarization waves - with protracted ischemic blood flow in compromised tissue. The extracellular microenvironment with high potassium and low nitric oxide tension can account for conducting vessel narrowing. CONCLUSIONS: The implication for clinical management is discussed supposing glial cell dysfunction is an underlying mechanism responsible for the vascular spasm. |
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Authors:
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W Alan C Mutch |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review Date: 2010-02-04 |
Journal Detail:
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Title: Canadian journal of anaesthesia = Journal canadien d'anesthésie Volume: 57 ISSN: 1496-8975 ISO Abbreviation: Can J Anaesth Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-04-26 Completed Date: 2010-08-03 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8701709 Medline TA: Can J Anaesth Country: United States |
Other Details:
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Languages: eng Pagination: 479-89 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, Anesthesia Research Laboratory, University of Manitoba, A504 Chown Building, 744 Bannatyne Avenue, Winnipeg, MB R3C 0W2, Canada. amutch@cc.umanitoba.ca |
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Blood Volume Cerebrovascular Circulation Hemodilution / methods Humans Hypertension Neuroglia / pathology* Nitric Oxide / metabolism Potassium / metabolism Subarachnoid Hemorrhage / complications*, physiopathology Vasospasm, Intracranial / etiology, physiopathology, therapy* |
| Chemical | |
Reg. No./Substance:
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10102-43-9/Nitric Oxide; 7440-09-7/Potassium |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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