• MeSH
• Cerebrovascular Disorders diagnosis   epidemiology   MeSH
• Intracranial Aneurysm MeSH
• Subarachnoid Hemorrhage MeSH
• Publication type
• Congress MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• kardiologie
• angiologie

• Keywords
• cerebrovaskulární nemoci, cévní mozkové příhody, oběhové poruchy mozku,

• Conspectus
• Anatomie člověka a srovnávací anatomie
• NML Fields
• neurologie
• angiologie

• MeSH
• Adult MeSH
• Brain Ischemia prevention & control   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Calcium antagonists & inhibitors   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

BACKGROUND: Clinically symptomatic vasospasm leading to delayed ischemic neurological deficits occurs in up to 30% of patients with subarachnoid hemorrhage (SAH). Vasospasm can result in a serious decline in clinical conditions of patients with SAH, yet the algorithm for vasospasm treatment and prevention remains unclear. Intra-arterial administration of vasodilators is one of the modalities used for vasospasm therapy. METHODS: Over the last 7 years, we have treated 27 female and 7 male patients with vasospasm using intra-arterial administration of either nimodipine or milrinone; all had suffered aneurysm rupture. Of these patients, 28 were treated surgically (clip), and 6 patients had their aneurysm coiled. Spasmolytics were applied from day 2 to day 18 after rupture. RESULTS: Of the 53 procedures, angiographic improvement was documented in 92% of cases with a mean flow velocity decrease of 65 cm/s. Brain metabolism changes were monitored after the procedure. The highest level of immediate clinical improvement was observed in conscious patients with a focal neurological deficit (aphasia, hemiparesis). Overall clinical outcomes (Glasgow outcome scale, GOS) were as follows: GOS 5 (12 patients), GOS 4 (5 patients), GOS 3 (5 patients), GOS 2 (6 patients), and GOS 1 (6 patients). CONCLUSIONS: Intra-arterial administration of spasmolytics is a safe and potent method of vasospasm treatment. It is most effective when applied to conscious patients with a focal deficit. For unconscious patients, its therapeutic benefits are inconclusive. Patients in severe clinical states would further require use of other diagnostic tools such as multimodal brain monitoring to complement vasospasm therapy.

• MeSH
• Angioplasty adverse effects   methods   MeSH
• Adult MeSH
• Infusions, Intra-Arterial adverse effects   MeSH
• Vasospasm, Intracranial drug therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Nimodipine administration & dosage   therapeutic use   MeSH
• Subarachnoid Hemorrhage drug therapy   MeSH
• Vasodilator Agents administration & dosage   therapeutic use   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Akutní končetinová ischemie je život ohrožující stav způsobený různorodými příčinami zahrnujícími trombózu nasedající na aterosklerotický plát a periferní embolizaci. U mladých jedinců je nicméně nutné zvažovat i jinou etiologii obtíží. Popisujeme vzácný případ 19letého muže s akutní končetinovou ischemií obou horních a dolních končetin zapříčiněnou prolongovaným vazospasmem.

Acute limb ischemia is a life-threatening condition caused by various etiologies including atherothrombosis and peripheral embolization. However, in young adults other etiologies should also be considered. We report a rare case of a 19-year-old man developing acute limb ischemia of both upper and lower limbs due to prolonged vasospasm.

• MeSH
• Computed Tomography Angiography methods   MeSH
• Coronary Vasospasm MeSH
• Humans MeSH
• Young Adult MeSH
• Peripheral Arterial Disease * diagnosis   etiology   therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Cíle: Cílem této studie je prokázat účinnost takrolimu (TAC), látky s imunosupresivními účinky díky inhibici kalcineurinu, v léčbě cerebrálních vazospazmů indukovaných subarachnoidální hemoragií (SAH) na modelu potkana. Materiály a metody: Do studie bylo po získání souhlasu etické komise zahrnuto 18 potkanů (samců) Sprague-Dawley. Potkani mohli v Morrisově vodním bludišti plavat ve čtyřech směrech, dokud nebylo dosaženo plató křivek kognitivních funkcí (4 dny). Po nácviku plaveb byly u potkanů v celkové anestezii fixovány všechny čtyři končetiny a hlava byla držena ve flexi pod úhlem 20° v pronační poloze. SAH byla indukována podáním 0,4 cm3/kg autologní arteriální krve do cisterna magna. Takrolimus (0,5 mg/kg, 2 dávky) byl podán intraperitoneálně pro léčbu indukovaného vazospazmu a byla hodnocena jeho účinnost. Závěr: Při porovnávání časů plaveb za 3 dny a ve všech směrech v kontrolní skupině a skupinách SAH a SAH-TAC bylo pozorováno snížení středních časů plaveb ve skupině, které byl po SAH podán takrolimus. V rámci analýzy rozptylu pomocí Kruskalova-Wallisova testu však nebyly v distribuci středních časů plaveb za tři dny pozorovány žádné signifikantní rozdíly mezi kontrolou a skupinami SAH a SAH-TAC na 95% intervalu spolehlivosti (p = 0,366).

Aim: The present study aims to demonstrate the efficacy of tacrolimus (TAC), an agent showing immunosuppressive effects through calcineurin inhibition, in the treatment of subarachnoid haemorrhage (SAH)-induced cerebral vasospasm in rat models. Material and Methods: The study, after gaining the approval of the ethics committee, included 18 male Sprague-Dawley rats which were allowed to swim in four directions within a Morris water maze until the cognitive function curves reached a plateau (4 days). After the retention swimming, four extremities were found while the rats were held in a prone position with the head at 20 degrees flexion under general anaesthesia. SAH was induced through the administration of 0.4 cc/ kg of autologous arterial blood into the cisterna magna. Tacrolimus (0.5 mg/ kg, 2 doses) was administered intraperitoneally for the treatment of the induced vasospasm, and its efficacy was investigated. Conclusion: When the three-day all-direction swimming times of the control, of SAH and SAH-TAC groups were compared, a decrease was noted in the mean times of swimming within the group administered with tacrolimus after SAH, although a Kruskal-Wallis variance analysis did not indicate any significant difference in the distribution of the mean three-day swimming times between control, SAH and SAH-TAC groups, at a 95% confidence interval (P = 0.366).

• MeSH
• Vasospasm, Intracranial drug therapy   MeSH
• Cognition drug effects   MeSH
• Disease Models, Animal MeSH
• Rats, Sprague-Dawley MeSH
• Tacrolimus * adverse effects   therapeutic use   MeSH
• Animals MeSH
• Check Tag
• Animals MeSH

Koronární vazospasmus je jednou z příčin akutních koronárních syndromů (AKS) u pacientů bez obstrukční formy aterosklerózy věnčitých tepen. Ve velké většině případů však nebývá diagnostikován, jeho záchyt při selektivní koronarografii během manifestace klinických potíží je totiž vzácný. Prezentujeme případ pa- cientky s AKS s elevacemi úseku ST (STEMI) spodní stěny, u které byl koronarograficky prokázán spontánní vazospasmus pravé věnčité tepny během akutní fáze onemocnění.

Coronary vasospasm may be the cause of the acute coronary syndrome (ACS) in patients without obstructive atherosclerosis of coronary arteries. In majority of cases it is not diagnosed, because it is rarely occurring situation to perform coronary angiography at the time of symptoms. We are introducing the case of a female patient with ACS with ST elevation (STEMI) where the vasospasm of the right coronary artery was established during the acute phase of the disease.

• MeSH
• Electrocardiography methods   MeSH
• Coronary Vasospasm * diagnosis   complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Angina Pectoris, Variant * diagnosis   drug therapy   MeSH
• Verapamil pharmacology   therapeutic use   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Research Support as Topic MeSH
• Hemodynamics drug effects   MeSH
• Vasospasm, Intracranial drug therapy   therapy   MeSH
• Intensive Care Units MeSH
• Humans MeSH
• Brain Injuries drug therapy   therapy   MeSH
• Review Literature as Topic MeSH
• Subarachnoid Hemorrhage, Traumatic drug therapy   therapy   MeSH
• Check Tag
• Humans MeSH

Cíl studie: Zhodnotit vliv klinického stavu pacienta při přijetí (Hunt Hesse, HH), léčebného výsledku (Glasgow Outcome Score, GOS) a přítomnosti vazospasmů na změny parciálního tlaku kyslíku v mozkové tkáni (PbtO2) v závislosti na změnách frakce kyslíku ve vdechované směsi (FiO2) u pacientů na umělé plicní ventilaci (UPV). Typ studie: Prospektivní intervenční studie. Typ pracoviště: Neurochirurgická klinika FN, Klinika anesteziologie, resuscitace a intenzivní medicíny. Materiál a metoda: U pacientů se subarachnoidálním krvácením při ruptuře aneurysmatu bylo prováděno 10denní monitorování PbtO2. Opakovaně byla prováděna diagnostika přítomností vazospasmů pomocí transkraniální dopplermetrie (TCD). U pacientů na UPV byl prováděn klinický pokus, při kterém bylo zvýšeno FiO2 na 1,0 a sledována dynamika změn PbtO2. Takto jsme pořídili 26 kontinuálních záznamů od 7 pacientů s diagnózou aneurysmatu arteria cerebri media (ACM). Hodnotili jsme vliv vazospasmů, klinického stavu pacienta při přijetí (HH) a outcome (GOS) na změny PbtO2 při zvýšení FiO2. Vyhodnocení bylo provedeno pomocí smíšených modelů. Výsledky: Prokázali jsme statisticky významný rozdíl v dynamice změn PbtO2 při zvýšení FiO2 v závislosti na HH, GOS a přítomnosti vazospasmů. U pacientů v lepším klinickém stavu (HH3) a s lepším outcome (GOS5) dochází k výraznějšímu nárůstu PbtO2 po zvýšení FiO2 na 1,0 (p < 0,001 u obou parametrů). U pacientů bez vazospasmů dochází k výraznějšímu nárůstu PbtO2 po zvýšení FiO2 než u pacientů s vazospasmy (p < 0,001). Závěr: Prokázali jsme vliv vazospasmů na dynamiku změn PbtO2 při zvyšování FiO2. Změny PbtO2 při zvyšování FiO2 mají souvislost i s dalšími faktory (HH, GOS).

Objective: Evaluation of the impact of the admission clinical status of subarachnoid haemorrhage (SAH) patients (Hunt Hesse Score, HH3), the outcome (Glasgow Outcome Score, GOS) and the presence of vasospasm on the changes in the brain tissue oxygen levels (PbtO2), in relation to changes of FiO2 in mechanically ventilated patients. Design: Prospective interventional study. Setting: Neurosurgical Department of University Hospital, Department of Anaesthesia and Resuscitation, University Hospital. Materials and methods. We monitored PbtO2 in patients with SAH due to aneurysm rupture for 10 days. Presence of vasospasms was repeatedly assessed with transcranial doppler (TCD). In patients on mechanical ventilation we performed the clinical trial. We increased the FiO2 to 1.0 and measured the dynamics of changes of PbtO2 simultaneously. Thus we obtained 26 continual measurements in the study group of 7 patients. The influence of vasospasm, the admission HH3 and GOS on changes of PbtO2 after an increase of FiO2 were evaluated. Mixed models analyses were used to evaluate the measured data. Results: In the study group we observed a significant difference in the dynamics of PbtO2 levels after an increase of FiO2 in relation to the patients‘ admission clinical status (HH3), outcome (GOS) and the presence of vasospasm. The levels of PbtO2 after an increase in FiO2 increased more in the patients with the better clinical status (HH3) and better outcome (GOS) (p < 0.001 in both parameters). In patients without vasospasm we found a significantly higher increase of PbtO2 levels after increasing FiO2 than in patients with vasospasm (p < 0.001). Conclusion: The dynamics of PbtO2 levels were influenced by vasospasm. The changes of PbtO2 levels after increasing FiO2 are also associated with other factors (HH, GOS).

• MeSH
• Monitoring, Ambulatory MeSH
• Adult MeSH
• Financing, Organized MeSH
• Intracranial Aneurysm complications   MeSH
• Vasospasm, Intracranial diagnosis   prevention & control   MeSH
• Humans MeSH
• Hypoxia-Ischemia, Brain diagnosis   metabolism   MeSH
• Oximetry methods   instrumentation   MeSH
• Prospective Studies MeSH
• Oxygen Consumption MeSH
• Subarachnoid Hemorrhage complications   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH

OBJECTIVE: The aim of this study was to evaluate the effect of preventive and therapeutic use of subarachnoid sodium nitroprusside (SNP) administration in patients with non-traumatic subarachnoid haemorrhage (SAH). METHODS: All consecutive adult patients admitted in the period 2000-2003 with SAH, Hunt-Hess grade I-IV, indicated for neurosurgical intervention, were enrolled in the study. In the postoperative period they were treated with mechanical ventilation and triple H protocol with nimodipine. Subarachnoid preventive SNP was administred in initial dose of 1 mg by catheter inserted into basal cisterns during the neurosurgical procedure. The timing of following dosage was directed by the changes of respiratory parameters of brain tissue in the region of interest by multiparameter sensor (Codman Neurotrend) and findings of blood flow velocity on the level of circle of Willis were measured by transcranial doppler ultrasonography (TCD). RESULTS: 17 patients were enrolled to study. All patients survived. No brain infarction developed. The increase blood flow velocity was found in three patients. CONCLUSION: Preventive subarachnoid use of SNP in combination with multimodal monitoring might be a possible preventive strategy. Its efficacy has to be proved on a greater group of patients in the future. The therapeutical use of SNP requires an increase in application rate.

• MeSH
• Adult MeSH
• Injections, Intraventricular MeSH
• Vasospasm, Intracranial diagnosis   etiology   prevention & control   MeSH
• Catheterization methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Nitroprusside administration & dosage   MeSH
• Aged MeSH
• Subarachnoid Hemorrhage diagnosis   drug therapy   complications   MeSH
• Subarachnoid Space drug effects   MeSH
• Vasodilator Agents administration & dosage   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Clinical Trial MeSH