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Vasospasm pharmacology

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Cerebral Vasospasm

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 104))

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Abstract

The basis for pharmacological treatment of cerebral vasospasm (CVS) is the triple-H therapy. However, the improvement of impaired cerebral blood flow by this unspecific procedure comprises severe complications. Therefore, several investigations were performed to discover treatment strategies closer related to the pathophysiological mechanisms of CVS. These more specific approaches may be classified into neuroprotective and vasodilatory compounds.

Most extensively investigated neuroprotective compounds are radical scavengers that improved outcome in some subgroups of patients only and were not implemented as standard treatment after SAH. First clinical investigations employing statins, Mg++, and erythropoietin, however, revealed promising results. The systemic use of Ca++-antagonists is an accepted standard treatment after SAH, although their efficacy remains unsatisfying and seems to be mediated by neuroprotection. Intraarterial or local application of Ca++-antagonists, however, prevented and released cerebral vasospasm in several series and may become an additional therapy.

The approach closest to the pathophysiology of cerebral vasospasm seems to interfere with the endothelin (ET) system. Recent investigations suggest that the inhibition of ET by an antagonist is an efficient approach to preventing cerebral vasospasm. The treatment of cerebral vasospasm by specific drugs should distinctively reduce delayed ischemic neurological deficit (DIND) and complications during the intensive care therapy after SAH.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Johann Wolfgang Goethe-University, Schleusenweg 2-16, D-60528, Frankfurt, Germany

    Hartmut Vatter & V. Seifert

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  1. Hartmut Vatter
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  2. V. Seifert
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Correspondence to Hartmut Vatter .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Medical Faculty of Istanbul, University of Istanbul, Istanbul, Turkey

    Talat Kırış

  2. Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, USA

    John H. Zhang

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© 2008 Springer-Verlag

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Vatter, H., Seifert, V. (2008). Vasospasm pharmacology. In: Kırış, T., Zhang, J.H. (eds) Cerebral Vasospasm. Acta Neurochirurgica Supplement, vol 104. Springer, Vienna. https://doi.org/10.1007/978-3-211-75718-5_22

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  • DOI: https://doi.org/10.1007/978-3-211-75718-5_22

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-75717-8

  • Online ISBN: 978-3-211-75718-5

  • eBook Packages: MedicineMedicine (R0)

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