ascorbic-acid and Intracranial-Aneurysm

The antiproteasic activity of alpha1-antitrypsin (alpha1-AT) is reduced in cases of subarachnoid hemorrhage from ruptured intracranial aneurysm and particularly in patients currently smoking; alpha1-AT is very sensitive to oxidant agents. About 50% of physiological anti-oxidant systemic capacity is represented by Vitamin A, E and C. Plasmatic amounts of alpha1-AT, alpha1-AT Collagenase Inhibitory Capacity (CIC) and levels of vitamin A, vitamin E and vitamin C were analyzed in 39 patients, 26 women and 13 men, operated for intracranial aneurysm; 11 patients with unruptured intracranial aneurysm were considered as controls while 28 patients were included within 12 hours from subarachnoid hemorrhage (SAH). Plasmatic levels of vitamin A and vitamin E were significantly lower (p=0.038 and p=0.0158) in patients suffering SAH than in controls, while no statistically significant differences were found in mean plasmatic vitamin C levels. Level of alpha1-AT was not statistically different in controls and in patients with SAH; however, the activity of alpha1-AT, evaluated as CIC, is significantly reduced in patients with SAH (p=0.019). We have observed that systemic plasmatic levels of vitamins did not significantly differ in relation to smoking habit. Vitamin A and E represent an important defensive system against free radicals reactions. Particularly, vitamin E acts as an antioxidant by scavenging free-radicals. A reduced anti-oxidant status might be related to the higher sensibility of alpha1-AT to oxidative reactions and the activity of alpha1-AT is dependent on the antioxidant capacity of liposoluble vitamins. We can speculate that an acute systemic oxidative stress condition might influence the rupture of intracranial aneurysms.

Topics: alpha 1-Antitrypsin; Antioxidants; Ascorbic Acid; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Oxidative Stress; Smoking; Subarachnoid Hemorrhage; Vitamin A; Vitamin E

To test the hypothesis that systemic administration of vitamin C, through its action of stimulating collagen synthesis and crosslinking, would decrease the recurrence and improve the occlusion of experimental aneurysms treated with platinum coils.. Experimental aneurysms were created in female rabbits and were embolized with platinum coils (>30% packing density). The animals were divided into three groups: group 1 (n=6) rabbits served as controls, group 2 (n=5) rabbits were fed with a vitamin C supplemented feed and group 3 (n=8) rabbits were medicated with vitamin C pills. Digital subtraction angiography was used to evaluate stability after embolization. Subjects were euthanized at 12 weeks after coil implantation, and serum vitamin C levels were then measured. Histological samples were examined with a grading system (range 0-12) based on the neck and dome features. Masson Trichrome staining was used to evaluate collagen deposition. Parametric data were analyzed with one way analysis of variance and non-parametric data were examined using a Kruskal-Wallis test.. There were no significant differences between groups in mean aneurysm size. Mean serum vitamin C concentration was significantly higher in group 3 and group 2 compared with group 1, while vitamin C levels between group 2 and group 3 were statistically comparable. Coil compaction was noted in one of six subjects in group 1 and in three of eight subjects in group 3. All of the remaining aneurysms in the test and control groups showed stable occlusion. There were no significant differences in histological scores or collagen deposition among groups.. Vitamin C supplementation following platinum coil embolization does not demonstrate improvement of long term occlusion rates of aneurysms.

Topics: Angiography, Digital Subtraction; Animals; Antioxidants; Ascorbic Acid; Collagen; Collagen Type I; Combined Modality Therapy; Embolization, Therapeutic; Food; Gene Expression; Intracranial Aneurysm; Platinum; Rabbits; Real-Time Polymerase Chain Reaction; Surgical Instruments; Tablets; Treatment Outcome

Symptomatic vasospasm (SVS) is still a major cause of poor outcome in cases undergoing early surgical intervention for ruptured intracranial aneurysm. Among the numbers of therapeutic trials to prevent and ameliorate neurological deterioration due to SVS, removal or quenching of oxy-hemoglobin (OxyHb) from subarachnoid colts and administration of Mg(2+) (Mg) have especially been expected to be effective. In this report the authors investigated the effect of continuous cisternal irrigation (CCI) with mock CSF containing ascorbic acid (ASA) and Mg, performed after early surgery for ruptured aneurysm.. Sixty-three cases which had received CCI were retrospectively compared with 40 control cases as to the incidence of SVS and outcome.. Incidence of SVS was significantly less frequent (P < 0.05) in the CCI group (11%) than in the control group (25%). Severe and definitive SVS requiring additional specific treatment occurred only in 3.2% of the CCI group, while 22.5% in the control (P < 0.01). Overall outcome at discharge was significantly better in the CCI group than in the control (P < 0.01).. Postoperative CCI with ASA and Mg was definitively effective in preventing SVS and in lessening severity of SVS if it occurs.

Topics: Aged; Ascorbic Acid; Cisterna Magna; Female; Glasgow Coma Scale; Humans; Intracranial Aneurysm; Magnesium; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric; Therapeutic Irrigation; Vasospasm, Intracranial

Topics: Adult; Aged; Aged, 80 and over; Ascorbic Acid; Cerebral Ventricles; Drainage; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Oxyhemoglobins; Subarachnoid Hemorrhage; Therapeutic Irrigation; Time Factors; Vasospasm, Intracranial

Topics: Adult; Aged; Aged, 80 and over; Ascorbic Acid; Cerebral Ventricles; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Plasminogen Activators; Subarachnoid Hemorrhage; Therapeutic Irrigation; Tomography, X-Ray Computed; Treatment Outcome; Urokinase-Type Plasminogen Activator; Vasospasm, Intracranial

Cisternal irrigation therapy with urokinase and ascorbic acid was introduced to prevent symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH). To dissolve and wash out the subarachnoid clot, cisternal irrigation with urokinase is used. Ascorbic acid is added to degenerate oxy-hemoglobin, one of the strongest spasmogenic substances, into verdohemelike products, which are nonspasmogenic. The efficacy and safety of this therapy were evaluated.. This therapy was performed consecutively in 217 patients. The degree of SAH of the patients was classified as Fisher CT Group 3, and the highest CT number (Hounsfield number) exceeded 60 in the SAH, which suggested a significant risk for symptomatic vasospasm. All patients underwent surgery within 72 hours from the onset of SAH. After clipping the aneurysm, irrigation tubes were placed in the Sylvian fissure (inlet) unilaterally or bilaterally and in the prepontine or chiasmal cistern (outlet). Lactated Ringer's solution with urokinase (120 IU/mL) and ascorbic acid (4 mg/mL) was infused at a rate of 30 mL/hour/side for approximately 10 days.. Of the 217 patients studied, symptomatic vasospasm was observed in 6 cases (2.8%), and two of these six cases (0.9%) demonstrated sequelae. The average total blood volume calculated from the drainage fluid was approximately 114 mL. Analysis of the absorption spectrum of the drainage fluid revealed disappearance of the oxy-hemoglobin-specific 576-nm peak. Complications occurred in eight patients during irrigation therapy; two patients experienced seizures, two patients developed meningitis, and four patients had an intracranial hemorrhage. However, all of these patients recovered without neurological deficits.. These results suggest that cisternal irrigation therapy with urokinase and ascorbic acid is effective in preventing symptomatic vasospasm after aneurysmal SAH.

Topics: Adult; Aged; Aged, 80 and over; Ascorbic Acid; Cisterna Magna; Clinical Protocols; Female; Free Radical Scavengers; Humans; Intracranial Aneurysm; Male; Middle Aged; Oxyhemoglobins; Plasminogen Activators; Radionuclide Imaging; Radiopharmaceuticals; Subarachnoid Hemorrhage; Technetium Tc 99m Pentetate; Therapeutic Irrigation; Tomography, X-Ray Computed; Treatment Outcome; Urokinase-Type Plasminogen Activator; Vasospasm, Intracranial

Topics: Antioxidants; Ascorbic Acid; Cisterna Magna; Humans; Intracranial Aneurysm; Plasminogen Activators; Subarachnoid Hemorrhage; Therapeutic Irrigation; Treatment Outcome; Urokinase-Type Plasminogen Activator; Vasospasm, Intracranial

Using microdialysis, levels of metabolites in the extracellular fluid of the cerebral cortex were monitored during neurovascular surgery (9 aneurysm and 5 extra-intracranial bypass operations). Our aim was to use microdialysis to detect any local ischemia which might be caused by brain retraction or temporary clipping. Parameters were therefore quantified whose levels in the dialysate are known to be influenced by ischemia (on-line pH, ascorbic acid, uric acid, glutathione, cysteine, glucose, lactate, glucose:lactate ratio). In the aneurysm series, on-line pH fell after introduction of the retractor, and in the majority of cases the other parameters also showed changes in accordance with ischemic conditions in the region of the probe. These changes disappeared at the end of retraction, or sometimes even before. During the bypass operations, there were no marked changes in on-line pH or in any of the measured parameters. However, in some of these patients values for the glucose:lactate ratio, ascorbic acid and uric acid lay outside the suggested basal levels for minimally disturbed cortex, indicating possible changes in metabolism caused by inadequate perfusion (carotid artery occlusion). We conclude that microdialysis is a sensitive method of detecting intraoperative changes in cerebral metabolism.

Topics: Ascorbic Acid; Biomarkers; Brain Ischemia; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Cortex; Cerebral Revascularization; Constriction; Cysteine; Energy Metabolism; Extracellular Space; Glucose; Glutathione; Humans; Hydrogen-Ion Concentration; Intracranial Aneurysm; Intraoperative Complications; Lactates; Microdialysis; Monitoring, Intraoperative; Sensitivity and Specificity; Subarachnoid Hemorrhage; Uric Acid

The authors present their results regarding the use of a buffered solution of glycerol 30%-sodium ascorbate 20% (GLIAS) for the treatment of brain oedema and intracranial hypertension. GLIAS was perfused intravenously in 80 patients with several types of brain oedema. In every patients serum and urinary osmolarity, diuresis, main blood and urine parameters, and ICP were monitored. Following GLIAS infusion an increase in plasma osmolarity was observed, changing the average basal value plus 13.4% after 15 min., 10.5% after 30'. At the same time there was a reduction of ICP and improvement in cerebral compliance. In each case there was a decrease in intracranial hypertension and brain oedema without significant collateral effects.

Topics: Adolescent; Adult; Aged; Ascorbic Acid; Brain Edema; Brain Injuries; Brain Neoplasms; Buffers; Cerebral Hemorrhage; Child; Dose-Response Relationship, Drug; Female; Glycerol; Humans; Hypertonic Solutions; Infusions, Intravenous; Intracranial Aneurysm; Intracranial Pressure; Male; Middle Aged; Postoperative Complications; Pseudotumor Cerebri

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Astrocytoma; Cerebral Hemorrhage; Congenital Abnormalities; Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage