Cerebral Vasospasm (eBook)

Front Cover 1
Cerebral Vasospasm 4
Copyright Page 5
CONTENTS 6
FOREWORD 12
ACKNOWLEDGMENTS 14
ABBREVIATIONS 16
CHAPTER 1. HISTORY 18
I. Introduction 18
II. Clinical Description 18
III. Pathology 19
IV. Radiology 20
V. Medical Aspects 24
VI. Etiology 26
VII. Surgical Aspects 28
VIII. Physiology 29
IX. State of the Art 31
X. Farewell Message 31
References 32
CHAPTER 2. EPIDEMIOLOGY 34
I. Introduction 34
II. Incidence of Subarachnoid Hemorrhage 36
III. Incidence of Vasospasm 37
IV. Timing of Angiography and Incidence of Vasospasm 38
V. Prognostic Factors for Vasospasm 39
Vl. Factors Unrelated to Vasospasm 46
VII. Effect of Vasospasm on Outcome 46
VIII. Influence of Surgery on Vasospasm 47
IX. Relative Significance of Vasospasm 52
X. Vasospasm and Cerebral Infarction 53
XI. The Incidence of Vasospasm over Time 54
XII. Vasospasm and Nonaneurysmal Subarachnoid Hemorrhage 55
XIII. Endovascular Coiling and Vasospasm 56
References 56
CHAPTER 3. HEMATOLOGY 61
I. Introduction 61
II. Blood 62
III. Coagulation 87
References 98
CHAPTER 4. PATHOLOGY AND PATHOGENESIS 104
I. Introduction 104
II. The Subarachnoid Space, Pia-arachnoid, Arachnoid Villi, and Cerebrospinal Fluid 106
III. Cytopathology of Cerebrospinal Fluid and Subarachnoid Hemorrhage 115
IV. Arterial Changes in Vasospasm 120
V. Changes in Composition of Cerebrospinal Fluid, Blood, and Adjacent Tissues 137
Vl. Cerebral Infarction from Vasospasm 160
References 177
CHAPTER 5. RADIOLOGY 192
I. Introduction 193
II. Angiography 194
III. CT Scan 199
IV. Transcranial Doppler Ultrasonography 211
V. Magnetic Resonance Imaging 220
Vl. Positron Emission Tomography 225
VII. Single Photon Emission Computed Tomography 226
VIII. Cerebral Blood Flow Studies 227
References 229
CHAPTER 6. PHARMACOLOGY 238
I. Introduction 239
II. General Considerations 240
III. Neurogenic Factors 242
IV. Biogenic Amines 243
V. Neuropeptide Transmitters 249
VI. Eicosanoids 252
VII. Endothelin 254
VIII. Blood and Cerebrospinal Fluid 265
IX. Hemoglobin 271
X. Nitric Oxide 288
XI. Nitrovasodilators 295
XII. Free Radicals 297
XIII. Recent Novel Pharmacological Approaches 306
References 306
CHAPTER 7. STRUCTURE, PHYSIOLOGY, AND BIOCHEMISTRY OF VASCULAR SMOOTH MUSCLE 330
I. Introduction 330
II. Tension, Tone, and Work 333
III. Structural Components 334
IV. Actin and Myosin 337
V. Modulating Proteins 340
VI. Relaxation 342
VII. Calcium 343
VIII. Enzymes, Receptors, and Messenger Systems 349
IX. Membrane Potential 360
X. Acidosis and Hypoxia 364
XI. Growth and Contraction 365
XII. Metabolism 365
References 366
CHAPTER 8. MEDICAL ASPECTS OF VASOSPASM 372
I. Introduction 372
II. Diagnosis 374
III. Differential Diagnosis 377
IV. Prophylaxis 381
V. Management of Delayed Ischemic Deficit 398
Vl. Therapy 400
VII. Randomized Clinical Trials 430
VIII. The Art of Treatment 435
References 435
CHAPTER 9. NONRUPTURED ANEURYSM VASOSPASM 448
I. Postoperative Cases 448
II. Vascular Lesions 449
III. Head Injury 450
IV. Infections 452
V. Eclampsia 453
VI. Migraine Headaches as a Vasoconstrictor Phenomenon 454
VII. Coronary Artery Vasospasm 454
References 455
CHAPTER 10. SURGICAL ASPECTS OF VASOSPASM 458
I. Surgical Trauma Mimicking or Aggravating Vasospasm 458
II. Clot Removal at Surgery 458
III. Timing of Surgery and Vasospasm 462
IV. Cisternal Drainage 463
V. Fibrinolytic Therapy and Surgery 465
References 466
CHAPTER 11. ANIMAL MODELS 468
I. Introduction 468
II. Models in Vitro 468
III. Acute Effects of SAH versus VSP 469
IV. Species Differences 469
V. Considerations in the Conduct of Animal Studies 470
VI. Creation of SAH 470
VII. Specific Animal Models 471
VIII. Ethical Considerations 485
References 486
CHAPTER 12. MOLECULAR BIOLOGY AND GENETICS 495
I. Introduction 495
II. Genetic Predisposition to Vasospasm 496
III. Molecular Biological Techniques 496
IV. Changes in Regulatory Mechanisms of Smooth Muscle Contraction 497
V. Changes in Smooth Muscle Relaxation Mechanisms 506
VI. Changes in Endothelium-Regulated Mechanisms 507
VII. Changes in Genes That May Influence Vasospasm 511
VIII. Microvascular Spasm 516
IX. Changes in the Brain 517
X. Gene Therapy 518
References 519
INDEX 528