Cerebral vasospasm: looking beyond vasoconstriction.
Cerebral vasospasm is an important syndrome that afflicts 30% of patients in the aftermath of, and secondary to, subarachnoid hemorrhage. Starting approximately one week after the hemorrhage, the condition worsens the prognosis of the hemorrhage significantly. Apart from general supportive care, no treatment exists for cerebral vasospasm. During the past 50 years, it was thought that the ischemia that signifies poor outcome is more or less exclusively caused by arterial narrowing. However, this idea has recently been challenged by the failure of the drug clazosentan to improve patient outcome, despite reversing vasoconstriction. In this article, we discuss the opinion that factors other than vasoconstriction are important in the pathophysiology and prognosis of cerebral vasospasm. Such factors include global ischemia, disruption of the blood-brain barrier, activation of apoptotic and inflammatory pathways, and cortical spreading depression.
Hansen-Schwartz
Jacob
J
Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen DK-2100, Denmark.
Vajkoczy
Peter
P
Macdonald
Robert Loch
RL
Pluta
Ryszard M
RM
Zhang
John H
JH
D001812:Blood-Brain Barrier; D002118:Calcium / Q000502:physiology; D002560:Cerebrovascular Circulation; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology; D009131:Muscle, Smooth, Vascular / Q000502:physiology; D011493:Protein Kinase C / Q000502:physiology; D014661:Vasoconstriction; D020301:Vasospasm, Intracranial / Q000503:physiopathology*; D054460:rho-Associated Kinases / Q000502:physiology
D054460:rho-Associated Kinases; D011493:Protein Kinase C; D002118:Calcium