Mechanism and treatment principle for cerebral vessel spasm caused by concussion.
OBJECTIVE
To discuss the mechanism of cerebral vessel spasm caused by concussion and the effect of Nimodipine on concussion.


METHODS
A total of 224 patients who were treated from March 1995 to October 1999 were divided into two groups randomly, ie, Nimodipine group (113 cases) and control group (111 cases). Middle cerebral artery (MCA), basilar artery (BA) and the average peak forward velocity of cerebral blood flow were observed by color three-dimensional transcranial Doppler (3D-TCD) within 24 hours after admission and at the end of 3-6 days of treatment. Cerebral blood flow changes, characteristics and treatment effect were analyzed and determined by clinical main symptom disappearance rate.


RESULTS
In concussion, cerebral blood flow was divided into 3 phases: cerebral blood flow low infusion dilation phase, cerebral blood vessel spasm phase and cerebral blood flow recovery phase. In the Nimodipine group, clinical main symptom disappearance rate was higher than that in the control group in the cerebral spasm and recovery phases with a significant difference (P < 0.01).


CONCLUSIONS
Cerebral vessel spasm, hypoxia and ischemia lesion are the main pathological changes. Whether cerebral dysfunction is reversible or not is mainly determined by spasm time of cerebral blood vessel. Nimodipine has a good effect on releasing spasm and diminishing the cerebral blood flow velocity. It not only improves curative effect on concussion, but also reduces and prevents concussion sequelae. Hence, concussion patients who have cerebral spasm confirmed by 3D-TCD should be given Nimodipine routinely and early.
Xiao
Xingyi
X
Emergency Department, 205th Hospital of PLA, Jinzhou 121001, China. 225205225205@sina.com
Guo
Xinhong
X
Wang
Dewen
D
Xue
Guansheng
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001924:Brain Concussion / Q000150:complications* / Q000000981:diagnostic imaging; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D008297:Male; D008353:Mannitol / Q000008:administration & dosage*; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage*; D012016:Reference Values; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology
D008353:Mannitol; D009553:Nimodipine