pharmacological treatment of delayed cerebral ischemia and vasospasm in subarachnoid hemorrhage药物治疗蛛网膜下腔出血的推迟脑缺血,血管痉挛.pdfVIP

Castanares-Zapatero and Hantson Annals of Intensive Care 2011, 1:12 /content/1/1/12 REVIEW Open Access Pharmacological treatment of delayed cerebral ischemia and vasospasm in subarachnoid hemorrhage * Diego Castanares-Zapatero and Philippe Hantson Abstract Subarachnoid hemorrhage after the rupture of a cerebral aneurysm is the cause of 6% to 8% of all cerebrovascular accidents involving 10 of 100,000 people each year. Despite effective treatment of the aneurysm, delayed cerebral ischemia (DCI) is observed in 30% of patients, with a peak on the tenth day, resulting in significant infirmity and mortality. Cerebral vasospasm occurs in more than half of all patients and is recognized as the main cause of delayed cerebral ischemia after subarachnoid hemorrhage. Its treatment comprises hemodynamic management and endovascular procedures. To date, the only drug shown to be efficacious on both the incidence of vasospasm and poor outcome is nimodipine. Given its modest effects, new pharmacological treatments are being developed to prevent and treat DCI. We review the different drugs currently being tested. Introduction blood flow (CBF) in the spastic arteries leads to DCI, Delayed cerebral ischemia (DCI) is a common and ser- which may develop into cerebral infarction [7,12,13]. ious complication following subarachnoid hemorrhage The etiology of vasospasm is complex and still poorly (SAH) after ruptured cerebral aneurismal [1,2]. understood. Several factors have been shown to be Although this complication is at times reversible, it involved, such as endothelial dysfunction, loss of autore- may develop into a