Acta neurochirurgica. Supplement
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Approximately 15% of all strokes are due to intracerebral hemorrhage (ICH) and of these, 5-10% occur in the cerebellum. The resultant mortality is around 20-30%. However, there is no well-established animal model to address this important clinical problem. ⋯ Females had mortality of 16%, while there was no mortality in male rats. Neurological deficits assessed by both beam walking and inclined plane were significantly increased at 0.4 and 0.6 U in females, but only at 0.6 for males. This new cerebellar hemorrhage rat model demonstrated dosage- and sex-dependent changes in hemorrhagic volume, brain edema, and neurological deficits, and could be used to test treatment strategies for ICH.
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Acta Neurochir. Suppl. · Jan 2008
Simvastatin attenuates cerebral vasospasm and improves outcomes by upregulation of PI3K/Akt pathway in a rat model of subarachnoid hemorrhage.
Cerebral vasospasm is a common sequelae of subarachonoid hemorrhage (SAH), however, the mechanism of cerebral vasospasm is still unclear. Recently, statins have been shown to have efficacy in ameliorating cerebral vasospasm. The present study investigates whether simvastatin attenuates cerebral vasospasm after subarachnoid hemorrhage (SAH) via upregulation of the PI3K/Akt pathway. ⋯ The beneficial effects of high dose simvastatin in ameliorating cerebral vasospasm are likely mediated by upregulation of the PI3K/Akt pathway.
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Intracerebral hemorrhage (ICH) is a subtype of stroke with very high mortality. Experiments have indicated that clot lysis and iron play an important role in ICH-induced brain injury. Iron overload occurs in the brain after ICH in rats. ⋯ Deferoxamine can rapidly penetrate the blood-brain barrier and accumulate in the brain tissue in significant concentration after systemic administration. We have demonstrated that deferoxamine reduces ICH-induced brain edema, neuronal death, brain atrophy, and neurological deficits. Iron chelation with deferoxamine could be a new therapy for ICH.
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Acta Neurochir. Suppl. · Jan 2008
Randomized Controlled Trial Clinical TrialPreliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial.
Compared to ischemic stroke, intracerebral hemorrhage (ICH) is easily and rapidly identified, occurs in younger patients, and produces relatively small initial injury to cerebral tissues--all factors suggesting that interventional amelioration is possible. Investigations from the last decade established that extent of ICH-mediated brain injury relates directly to blood clot volume and duration of blood exposure to brain tissue. Using minimally-invasive surgery plus recombinant tissue plasminogen activator (rtPA), MISTIE investigators explored aggressive avenues to treat ICH. ⋯ There is tentative indication that minimally-invasive surgery plus rtPA shows greater clot resolution than traditional medical management.
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Acta Neurochir. Suppl. · Jan 2008
ReviewNovel treatments for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Cerebral vasospasm is a major cause of cerebral ischemia and poor outcomes in the setting of aneurysmal subarachnoid hemorrhage (SAH). Despite advances in diagnosis and treatment of SAH, the pathophysiology of vasospasm is still poorly understood and outcomes remain disappointing. Recent advances in understanding the role of hemoglobin in initiating an inflammatory cascade in the subarachnoid space open new avenues for therapy. Preliminary experimental and clinical evidence indicate that targets in the inflammatory and oxidative cascades hold promise in reducing the incidence and impact of cerebral vasospasm.