Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage. | Available online http content 11 4 220 Review Clinical review Prevention and therapy of vasospasm in subarachnoid hemorrhage Salah G Keyrouz and Michael N Diringer Neurology Neurosurgery Intensive Care Unit Department of Neurology Washington University School of Medicine South Euclid Avenue St Louis MO 63110 USA Corresponding author Salah G Keyrouz salahkeyrouz@ Published 14 August 2007 This article is online at http content 11 4 220 2007 BioMed Central Ltd Critical Care 2007 11 220 doi cc5958 Abstract Vasospasm is one of the leading causes of morbidity and mortality following aneurysmal subarachnoid hemorrhage SAH . Radiographic vasospasm usually develops between 5 and 15 days after the initial hemorrhage and is associated with clinically apparent delayed ischemic neurological deficits DID in one-third of patients. The pathophysiology of this reversible vasculopathy is not fully understood but appears to involve structural changes and biochemical alterations at the levels of the vascular endothelium and smooth muscle cells. Blood in the subarachnoid space is believed to trigger these changes. In addition cerebral perfusion may be concurrently impaired by hypovolemia and impaired cerebral autoregulatory function. The combined effects of these processes can lead to reduction in cerebral blood flow so severe as to cause ischemia leading to infarction. Diagnosis is made by some combination of clinical cerebral angiographic and trans-cranial doppler ultrasonographic factors. Nimodipine a calcium channel antagonist is so far the only available therapy with proven benefit for reducing the impact of DID. Aggressive therapy combining hemodynamic augmentation transluminal balloon angioplasty and intra-arterial infusion of vasodilator drugs is to varying degrees usually implemented. A panoply of drugs with different mechanisms of action has been studied in SAH related vasospasm. Currently the most promising are magnesium sulfate .
