ascorbic-acid and Vasospasm--Intracranial

Cerebral vasospasm (CVS) is a common serious complication after the spontaneous subarachnoid hemorrhage (SAH). Despite recent advances in medical and surgical treatments, the 30-day mortality rate of SAH remains high, and there is lack of especially effective clinical treatment to alleviate and improve CVS. The present study has investigated the therapeutic effect of insulin and vitamin C on CVS after SAH.. Five days after SAH, there is obvious basilar artery spasm in SAH group, whose average vascular cross-sectional area (233,099 ± 16,750 μm²) is significantly smaller than that in control group (462,128 ± 74,756 μm²), which is also significantly different from those in SAH + insulin group (221,114 ± 43,457 μm²) and SAH + vitamin C group (237,820 ± 21,703 μm²). SAH + insulin + vitamin C group shows no evident vasospasm and maintains a vascular cross-sectional area of 425,530 ± 45,503 μm², which is significantly different from that in SAH group. Insulin receptor α (InRα) expression is significantly downregulated in the vascular endothelial cells of SAH, SAH + insulin, and SAH + vitamin C groups (P < 0.01) but remains unchanged in vascular endothelial cells of SAH + insulin + vitamin C group (P > 0.05). Five days after SAH, serum and cerebrospinal fluid NO levels in SAH, SAH + insulin, and SAH + vitamin C groups decrease significantly (P < 0.01) compared to that in control group, whereas the reduction is not evident in SAH + insulin + vitamin C group (P > 0.05).. Combinatorial treatment with insulin and vitamin C has effectively relieved the CVS after SAH in rabbit, possibly through increasing the InRα expression and NO level, whereas treatment with insulin or vitamin C alone fails to do so.

Topics: Animals; Ascorbic Acid; Disease Models, Animal; Drug Therapy, Combination; Hypoglycemic Agents; Insulin; Rabbits; Subarachnoid Hemorrhage; Vasospasm, Intracranial; Vitamins

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