Cerebral vasospasm after subarachnoid hemorrhage

@article{Janjua2003CerebralVA,
  title={Cerebral vasospasm after subarachnoid hemorrhage},
  author={Nazli A Janjua and Stephan A. Mayer},
  journal={Current Opinion in Critical Care},
  year={2003},
  volume={9},
  pages={113-119}
}
Purpose of reviewTo summarize new pathophysiologic insights and recent advances in the diagnosis and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Recent findingsImportant, newly recognized mediators of cerebral arterial spasm after subarachnoid hemorrhage include superoxide free radicals, ferrous hemoglobin (which acts as a nitric oxide scavenger), endothelins, protein kinase C, and &rgr; kinase. Microvascular dysfunction and autoregulatory failure also has been an… 

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Bilirubin Oxidation Products (BOXes) and Their Role in Cerebral Vasospasm after Subarachnoid Hemorrhage

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Recent evidence that BOXes play a role in SAH-induced vasospasm is summarized and either blocking bilirubin formation, inactivating bilirUBin or BOXes, or removing all of the blood clot before vasospasms are potential treatment targets.
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References

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Asymptomatic vasospasm in patients with aneurysmal SAH is studied to assess whether DWI provides predictive markers of silent ischemic lesions and/or progression toward symptomatic ischemia, and whether the apparent diffusion coefficients (ADCs) have a reversibility threshold.

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Progress is being made in identifying the various components in the blood that cause SAH-induced vasospasm and evolving understanding of the underlying molecular mechanism may provide the basis for improved treatment after SAH, especially at the level of the microcirculation.

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Changes of cerebral hemodynamics and oxygenation in patients with cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) might be underestimated if transcranial Doppler sonography (TCD) and

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It is suggested that milrinone was effective and safe for the treatment of cerebral vasospasm after subarachnoid hemorrhage in the patients in this series and holds promise as a clinically advantageous treatment regimen.

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In order to be able to acutely assess and select the patients suspected of suffering from vasospasm ischemia, it is necessary to dispose of a sensitive and specific modality that is able to both detect acutely ischemIA and to exclude other causes of brain dysfunction.
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