The functional reversibility of cerebral blood vessel with spasm and effect of calcium antagonist (Diltiazem)
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To elucidate when blood vessel with spasm becomes functionally irreversible in terms of physiological function of vasoconstriction-vasodilation is believed to be an important guideline of selecting an adequate therapeutic method for cerebral vasospasm.<BR>We studied the relation of behavior of electrical discharge of vascular smooth muscle with isometric vascular contraction and histological change of vascular wall in order to know the functional reversibility of blood vessel with spasm by using cerebrovascular specimens of 27 human autopsy cases that had died of SAH or other diseases. Grouping discharge and sporadic discharge were detected in 7 and 4 cases of non-SAH group (13 cases) respectively, indicating good vascoconstriction. No evidence of muscle necrosis were disclosed histologically. Contrarily, grouping discharge was not detected in SAH group (14 cases), excepting that sporadic discharge was detected in 5 cases with local narrowing of the blood vessel. Muscle discharge and vascoconstriction were rarely seen in the cases with prolonged cerebral vasospasm while extensive muscle necrosis was observed. Muscle discharge was detected in those who died within a week after the onset of cerebral vasospasm or those with local narrowing of the blood vessel. It seemed likely that the functional reversibility of blood vessel with spasm is lost at about one week after the onset of cerebral vasospasm.<BR>The efficacy of a calcium antagonist, diltiazem, on cerebral vasospasm was evaluated in 26 cases with intracranial aneurysm. In general, following an intravenous one shot of 20 mg of diltiazem, 60 mg per day was infused continuously by intravenous drip for 7 successive days. In therapeutic group, improvement of clinical symptoms including disturbance of consciousness, hemiplegia and aphasia and relief of cerebral vasospasm were obtained in 4 of the 8 cases with cerebal vasospasm resulting from SAH and 7 of the 9 cases with postoperative cerebral vasospasm. The clinical symptoms began to improve at 24-72 hours after starting the medication and the improvement preceded complete relief of cerebral vasospasm. The effectively treated cases were limited to those who were started on diltiazem therapy within 5 or 6 days after the onset of cerebral vasospasm. Those who received the drug more than 6 days after the onset of the symptom failed to respond to the drug. this result is in good agreement with the result of a fundamental study which demonstrated that the functional reversibility of blood vessel with spasm is lost at about one week after the onset of cerebral vasospasm.<BR>Mild cerebral vasospasm occurred in 2 cases of preventive group (9 cases), but the symptom progressed in very slight or asymptomatic state.<BR>It is concluded that calcium antagonist therapy should be initiated in the early stage of cerebral vasopasm or the drug should be administered to prevent the onset of cerebral vasospasm.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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