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New concepts regarding cerebral vasospasm: glial-centric mechanisms

lxg1983 添加于 2010-3-30 23:15 | 1538 次阅读 | 0 个评论

作者
Mutch WA
摘要
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.
详细资料
- 文献种类:期刊
- 期刊名称: Canadian Journal of Anaesthesia = Journal Canadien d'Anesthesie
- 期刊缩写: Can J Anaesth
- 期卷页: 2010年
- 地址: Department of Anesthesia, Anesthesia Research Laboratory, University of Manitoba, A504 Chown Building, 744 Bannatyne Avenue, Winnipeg, MB R3C 0W2, Canada, amutch@cc.umanitoba.ca
- ISBN: 0832-610X
- 备注:PMID:20131107
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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.

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