Cerebral vasospasm after subarachnoid hemorrhage: the emerging revolution

被引：303
作者：
Macdonald, R. Loch
Pluta, Ryszard M.
Zhang, John H.
机构：
[1] Univ Toronto, St Michaels Hosp, Div Neurosurg, Toronto, ON M5B 1W8, Canada
[2] NINDS, Surg Neurol Branch, NIH, Bethesda, MD USA
[3] Loma Linda Univ, Physiol Grad Program, Loma Linda, CA 92350 USA
来源：
NATURE CLINICAL PRACTICE NEUROLOGY | 2007年 / 3卷 / 05期
关键词：
cerebral vasospasm; cortical spreading depression; endothelin; International Conference on Cerebral Vasospasm; subarachnoid hemorrhage;
D O I：
10.1038/ncpneuro0490
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
Cerebral vasospasm is the classic cause of delayed neurological deterioration after aneurysmal subarachnoid hemorrhage, leading and thus to poor outcome and to cerebral ischemia and infarction occasionally death. Advances in diagnosis and treatment-principally the use of nimodipine, intensive care management, hemodynamic manipulations and endovascular neuroradiology procedures-have a improved the prospects for these patients, but outcomes remain disappointing. Recent clinical trials have demonstrated marked prevention of vasospasm with the endothelin receptor antagonist clazosentan, yet patient outcome was not improved. This Review considers possible explanations for this result and proposes alternative causes of neurological deterioration and poor outcome after subarachnoid hemorrhage, including delayed effects of global cerebral ischemia, thromboembolism, microcirculatory dysfunction and cortical spreading depression.
引用
收藏
页码：256 / 263
页数：8
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