Successful prevention of neurological deficit in SAH patients with 2-chlorodeoxyadenosine.
Twenty patients suffering from subarachnoid haemorrhage due to ruptured intracranial aneurysm and operated on within 72 h after SAH were treated with an experimental immunosuppressive drug 2-chlorodeoxyadenosine (2-CDA), dose 0.05 mg/kg/day i.v. for 7 days. The 2-CDA treatment was started immediately after angiographic confirmation of ruptured aneurysm, and the standard pharmacological treatment (nimodipine and steroids) was also given. 50% of patients were severely threatened by "delayed vasospasm" or late neurological deficit (Fisher's score 3 or 4). The neurological outcome (assessed 8-12 weeks after SAH) was good (GOS = 1) in 70%, and fair (moderate disability, GOS = 2) in 25%. A single case of severe disability (GOS = 3), as well as two cases of less than perfect outcome (GOS = 2), were related to unusual pre- or intraoperative complications. We conclude that the low doses of 2-CDA can be considered as a valuable adjunct to the standard pharmacotherapy of SAH patients operated on early.
Ryba
M
M
Department of Neurophysiology, Polish Academy of Sciences Medical Research Centre, Warsaw.
Grieb
P
P
Pastuszko
M
M
Bidziński
J
J
Andrychowski
J
J
Dziewiecki
C
C
Bojarski
P
P
Królicki
L
L
D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D001921:Brain / Q000098:blood supply / Q000187:drug effects; D017338:Cladribine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D011292:Premedication; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D017338:Cladribine