Journal of neurosurgery
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Journal of neurosurgery · Mar 1987
Clinical Trial Controlled Clinical TrialPain relief by electrical stimulation of the periaqueductal and periventricular gray matter. Evidence for a non-opioid mechanism.
Pain relief following stimulation of the periaqueductal gray matter (PAG) or periventricular gray matter (PVG) in man has been ascribed to stimulation-induced release of endogenous opioid substances. Forty-five patients were studied and followed for at least 1 year after placement of chronic stimulating electrodes in the PAG or PVG to determine if pain relief due to stimulation could be ascribed to an endogenous opioid mechanism. Three criteria were assessed: the development of tolerance to stimulation; the possibility of cross-tolerance to morphine; and reversibility of stimulation-induced pain relief by the opiate antagonist naloxone. ⋯ The pain-relieving effect of PAG-PVG stimulation was reversed to an approximately equal degree by naloxone and placebo. The authors do not believe that, in most patients, pain relief elicited by PAG-PVG stimulation depends on an endogenous opioid mechanism. It appears that other, non-opioid mechanisms are primarily responsible for such pain relief.
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Journal of neurosurgery · Mar 1987
Case ReportsMultiple intracranial aneurysms due to Coccidioides immitis infection. Case report.
True mycotic (fungal) aneurysms are distinctly uncommon. The case of a young woman with multiple intracranial aneurysms of Coccidioides immitis origin is presented. ⋯ There are no previous reports of a coccidioidal mycotic aneurysm. The management of intracranial coccidioidomycosis and fungal aneurysms is reviewed.
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Journal of neurosurgery · Mar 1987
Effect of a calcium channel blocker on posttraumatic spinal cord blood flow.
The normal rat spinal cord blood flow (SCBF) has been shown to increase after administration of nimodipine, a calcium channel blocker. The present study investigates the capability of nimodipine to improve SCBF, as measured by the hydrogen clearance technique, after a 53.0-gm clip compression injury to the T-1 segment of the rat spinal cord. The profound drop in mean systemic arterial blood pressure (MSAP) after cervical cord injury precluded any improvement in posttraumatic SCBF by nimodipine alone. ⋯ The maintenance of an adequate MSAP by a pressor agent was crucial for nimodipine to improve posttraumatic SCBF by its ability to dilate the spinal vascular bed. Adrenaline was the only pressor agent that could fulfill the above criteria, although other pressor agents need to be investigated. Experiments are underway with the combination of adrenaline and nimodipine to further verify these encouraging results demonstrating an improvement in posttraumatic ischemia of the spinal cord.