Effects of common medications on cerebral vasospasm after subarachnoid haemorrhage

Abstract

Cerebral vasospasm is a common and serious complication of aneurysmal subarachnoid haemorrhage (SAH). At present, no consistently effective preventative and therapeutic measures are available, perhaps because of incomplete understanding of the pathogenesis of vasospasm. Experimental studies provide evidence that the incidence and severity of vasospasm after SAH can be modulated by drugs that affect neurotransmitter levels, intracellular signalling mechanisms, vascular smooth muscle function, inflammation and cellular proliferation, and the concentration of 'spasmogenic' factors. Preliminary clinical studies indicate that some illicit drugs and common prescription medications can have similar effects in humans. Recognition of these pharmacological effects is important because medications that can worsen or alleviate vasospasm are frequently administered to SAH patients to treat coincident medical problems.

Intravenous Anakinra can Achieve Experimentally Effective Concentrations in the Central Nervous System within a Therapeutic Time Window: Results of a Dose-Ranging Study

“…Apart from the use of calcium channel blocker nimodipine in SAH (Dorhout Mees et al , 2007), no pharmacological agent has been proven to improve outcome in hemorrhagic stroke, intracerebral hemorrhage, or SAH. Moreover, side effects resulting from administration of nimodipine occasionally limit its use (Topcuoglu and Singhal, 2006). …”

Impact of treatment with pravastatin on delayed ischemic disease and mortality after aneurysmal subarachnoid hemorrhage

“…Statins have neuroprotective properties including improved vasomotor reactivity, reduced platelet activation and anti-inflammatory effects [1]. A prospective observational controlled study was conducted to evaluate the impact of pravastatin on the development of delayed ischemic disease (DID) and ICU mortality after aneurysmal subarachnoid hemorrhage (aSAH).…”