Stroke; a journal of cerebral circulation
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Clinical Trial
Effect of intra-arterial papaverine on regional cerebral blood flow in hemodynamically relevant cerebral vasospasm.
It remains controversial whether the intra-arterial administration of papaverine (IAP) is effective in reversing vasospasm-associated cerebral hypoperfusion after aneurysmal subarachnoid hemorrhage. The aim of the present study was to continuously assess regional cerebral blood flow (rCBF) during and after IAP with the use of quantitative, bedside thermal diffusion flowmetry. ⋯ IAP is not effective in permanently reversing cerebral hypoperfusion in patients with cerebral vasospasm. The need to validate alternative therapeutic strategies that seek to improve cerebral perfusion in vasospasm warrants continued development of CBF-based neuromonitoring strategies.
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Several studies have claimed that temperature on admission is of prognostic significance in acute stroke. Experimental studies showing that hyperthermia increases infarct size have lent credibility to this assumption. The aim of the present study was to test the hypothesis that initial body temperature is of importance for stroke outcome. ⋯ In major stroke, a significant rise in temperature occurred hours after stroke onset. Severe infarcts and intracerebral hemorrhages caused temperature to rise, whereas initially increased temperature had no influence on stroke severity. Elevated body temperature on admission within 6 hours of stroke onset had no prognostic influence on stroke outcome at 3 months.
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We examined the neuroprotective efficacy of moderate-dose human albumin therapy in acute focal ischemic stroke and defined the therapeutic window after stroke onset, within which this therapy would confer neurobehavioral and histopathological neuroprotection. ⋯ Moderate-dose albumin therapy markedly improves neurological function and reduces infarction volume and brain swelling, even when treatment is delayed up to 4 hours after onset of ischemia.
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Extracellular ATP might induce cerebral vasospasm after subarachnoid hemorrhage through P(2) receptor. To investigate the roles of P(2) receptor subtypes in vasospasm, we examined the changes in mRNA expression of P(2) receptor subtypes in basilar arteries from double cisternal blood injection rat models. ⋯ The differential expression of the P(2) receptors indicates that P(2X1) subtype might not play an important role in vasospasm. The upregulation of P(2Y1) and P(2Y2) receptors might enable ATP to produce contraction at low levels of concentration.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Tolerability of the low-affinity, use-dependent NMDA antagonist AR-R15896AR in stroke patients: a dose-ranging study.
AR-R15896AR is a use-dependent, low-affinity blocker of the NMDA ion channel with neuroprotective effects in animal models of focal cerebral ischemia. This study aimed to establish the highest safe and tolerated loading and maintenance dosing regimen of AR-R15896AR in acute ischemic stroke patients and to determine the associated plasma concentrations of AR-R15896AR. ⋯ The maximum tolerated loading infusion of AR-R15896AR in this study was 250 mg over a period of 1 hour. Subsequent maintenance infusions of 120 mg every 8 hours were well tolerated. With these doses, putative neuroprotective concentrations of 1240 ng/mL are attained by the loading dose and are satisfactorily maintained thereafter. The loading dose may be improved further by adjustment on an individual patient basis, but tolerability issues remain.