Neurological research
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Neurological research · Jul 2009
Review Case ReportsPeri-operative measures for treatment and prevention of cerebral vasospasm following subarachnoid hemorrhage.
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high early mortality rates. Cerebral vasospasm remains the major source of morbidity after aSAH. Angiographic evidence of vasospasm is apparent in 70% of patients, while clinical manifestation of vasospasm is present in one third of patients. Early or existing vasospasm at the time of presentation poses an additional challenge in the management of the patient, and forms the basis for this review. ⋯ The utilization of a multimodality approach to treat patients with aneurysmal subarachnoid hemorrhage presenting with existing vasospasm can result in good outcome.
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Neurological research · Jul 2009
ReviewNear infrared technology in neuroscience: past, present and future.
To review past, present and future applications of near-infrared spectroscopy (NIRS) in clinical neuroscience. ⋯ Despite remarkable developments in the NIRS technology and proven reliability of the cerebral oxygenation monitoring approach, TCCO remains mostly an adjuvant tool for neuroscience applications. Newer NIRS technologies have become a source of quantitative information about brain oxygenation, cerebral blood volume and flow. However, the clinical significance of this new information in the context of clinical neuroscience will need to be determined and further validation studies will need to be performed.
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The vast amount of literature on the pharmaceutical treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage remains daunting. Optimal treatment regimens for patients can be obscured by studies not statistically powered to draw evidenced-based conclusions. ⋯ As the understanding of the pathophysiological mechanisms of vasospasm after aneurysmal subarachnoid hemorrhage evolves in the basic science laboratory, novel medications are being trialed in humans. However, significantly more work must be carried out in this area before we have an effective medical treatment that can prevent or reverse the devastating events of cerebral vasospasm.
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Neurological research · Jul 2009
Comparative StudyRetrospective analysis of parenteral magnesium sulfate administration in decreased incidence of clinical and neuroradiological cerebral vasospasm: a single center experience.
Experimental work suggests a neuroprotective role for magnesium sulfate in aneurysmal subarachnoid hemorrhage. We retrospectively review the incidence of clinically relevant vasospasm in patients treated or not with continuous magnesium infusion after onset of subarachnoid hemorrhage. ⋯ Continuous magnesium sulfate infusion for the management of clinically significant cerebral vasospasm is safe and reduces the incidence of clinically significant cerebral vasospasm. Large, multicenter, controlled studies should be performed in order to determine the true effectiveness of the treatment in a controlled setting.