Haemodynamic and metabolic disturbances in the acute stage of subarachnoid haemorrhage demonstrated by PET

Frykholm, Peter; Andersson, Jacob; Långström, Bengt; Persson, Lennart; Enblad, Per

doi:10.1034/j.1600-0404.2003.00174.x

Cited by 48 publications

(28 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, many such studies have investigated the cerebral circulation and metabolism during delayed CVS, and few have examined the cerebral circulation and metabolism in the early stage before the development of delayed CVS. [5][6][7]11,20,25,26) The cerebral circulation is impaired from the early stages after SAH onwards and CBF is markedly reduced in severe cases. 23) We also confirmed that CBF decreased as the neurological grade increased.…”

Section: Discussionmentioning

confidence: 99%

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

Honda

Sase

Yokota

et al. 2012

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR] ). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

Honda

Sase

Yokota

et al. 2012

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

show abstract

“…The data suggest that BOXes stress cells, alter actin architecture, increase LDH release and stimulate respiration by activating ATPases such as myosin ATPase (Butler et al, 1996;Takagi et al, 1989). The occurrence of these events in vivo would contribute to vasospasm/lumenal narrowing, especially if the contractile protein myosin ATPase was stimulated (Butler et al, 1996;Frykholm et al, 2004;Petzold et al, 2003). Bilirubin oxidation products induced changes in contractile proteins in smooth muscle cells might explain that the vessels with chronic vasospasm after SAH are resistant to various types of vasodilatory treatments, so much so that angioplasty is now often used to physically dilate these narrowed vessels (Bejjani et al, 1998;Coyne et al, 1994;Janjua and Mayer, 2003;Zubkov et al, 1999).…”

Section: Boxes Injure Smooth Muscle Cells In Culturementioning

confidence: 97%

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

Clark

Sharp

2006

J Cereb Blood Flow Metab

110

View full text Add to dashboard Cite

Many factors have been postulated to cause delayed subarachnoid hemorrhage (SAH)-induced vasospasm, including hemoglobin, nitric oxide, endothelin, and free radicals. We propose that free radicals (because of the high levels that are produced in the blood clots surrounding blood vessels after SAH) act on bilirubin, biliverdin, and possibly heme to produce BOXes (Bilirubin OXidized Products). Bilirubin oxidation products act on vascular smooth muscle cells to produce chronic vasoconstriction and vasospasm combined with a vasculopathy because of smooth muscle cell injury. This review summarizes recent evidence that BOXes play a role in SAH-induced vasospasm. The data supporting a role for BOXes includes (1) identification of molecules in cerebrospinal fluid (CSF) of patients with vasospasm after SAH that have structures consistent with BOXes; (2) BOXes are vasoactive in vitro and mimic the biochemical actions of CSF of patients with vasospasm; (3) BOXes are vasoactive in vivo, constricting rat cerebral vessels; and (4) there is a correlation between clinical occurrence of vasospasm and BOXes concentration in our preliminary study of patients with SAH. Since oxidation of bilirubin, biliverdin, and perhaps heme is proposed to produce BOXes that contribute to vasospasm, either blocking bilirubin formation, inactivating bilirubin or BOXes, or removing all of the blood clot before vasospasm are potential treatment targets.

show abstract

“…Their common thread is that higher scores indicate worse clinical condition and result in worse outcomes. SAH results in hemodynamic instability, metabolic disturbances, and neurocardiogenic injury including ventricular dysfunction, cardiac enzyme leak, and electrocardiographic abnormalities (33)(34)(35)(36)(37)(38).…”

Section: Incidence Of Aneurysms and Effects Of Rupturementioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: Update for Emergency Physicians

Edlow

Malek

Ogilvy

2008

The Journal of Emergency Medicine

105

View full text Add to dashboard Cite

Haemodynamic and metabolic disturbances in the acute stage of subarachnoid haemorrhage demonstrated by PET

Cited by 48 publications

References 33 publications

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

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

Aneurysmal Subarachnoid Hemorrhage: Update for Emergency Physicians

Contact Info

Product

Resources

About