Cerebral Vasospasm - 1st Edition - ISBN: 9780124641617, 9780080528830

Cerebral Vasospasm

1st Edition

Authors: R. Macdonald Bruce Weir
eBook ISBN: 9780080528830
Hardcover ISBN: 9780124641617
Imprint: Academic Press
Published Date: 12th March 2001
Page Count: 518
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Bryce Weir is a high-profile, respected neurologist. Dr. Macdonald is a colleague of Dr. Weir's and is a "rising star" in the field of neurology. This book is the first to cover all aspects of cerebral vasospasm in depth. It takes the reader from the first descriptions of this puzzling and deadly phenomenon to the latest laboratory evidence explaining its pathophysiology. Packed with clinical pearls, it is a must for neurosurgeons, interventional radiologists, neurologists, and neuropathologists.

Key Features

@introbul:Key Features @bul:* Examines the current understanding of vascular smooth muscle physiology

  • Provides in-depth overviews of symptoms and treatments
  • Written by acknowledged experts on the subject
  • Vividly illustrated with beautiful photographs and diagrams
  • Cites over 4,000 key papers on vasospasms
  • Presents key data in an easy-to-use format


Students and researchers in neuroscience and neurology

Table of Contents




Chapter 1 History

I. Introduction

II. Clinical Description

III. Pathology

IV. Radiology

A. Angiography

B. Computed Tomography

C. Blood Flow Measurements

D. Transcranial Doppler

V. Medical Aspects

A. Hemodynamic Therapy

B. Avoidance of Adverse Factors

C. Vasodilator and Neuroprotectant Medication

VI. Etiology

VII. Surgical Aspects

A. Clot Removal

B. Timing of Surgery

C. Angioplasty

VIII. Physiology

IX. State of the Art

X. Farewell Message


Chapter 2 Epidemiology

I. Introduction

II. Incidence of Subarachnoid Hemorrhage

III. Incidence of Vasospasm

IV. Timing of Angiography and Incidence of Vasospasm

V. Prognostic Factors for Vasospasm

A. Blood on CT Scan

B. Hypertension

C. Anatomical and Systemic Factors

D. Clinical Grade

E. Antifibrinolytics

F. Age and Sex

G. Smoking

H. Physiological Parameters

I. Hydrocephalus

VI. Factors Unrelated to Vasospasm

VII. Effect of Vasospasm on Outcome

VIII. Influence of Surgery on Vasospasm

IX. Relative Significance of Vasospasm

X. Vasospasm and Cerebral Infarction

XI. The Incidence of Vasospasm over Time

XII. Vasospasm and Nonaneurysmal Subarachnoid Hemorrhage

A. Nonaneurysmal Subarachnoid Hemorrhage

B. Arteriovenous Malformations

C. Other Causes

XIII. Endovascular Coiling and Vasospasm


Chapter 3 Hematology

I. Introduction

II. Blood

A. Cellular Elements

B. Plasma

C. Erythrocytes

D. Endothelial Cells

E. Platelets

F. Neutrophils

G. Mast Cells and Basophils

H. Eosinophils

I. Monocytes and Macrophages

J. Lymphocytes

III. Coagulation

A. Coagulation Pathways

B. Coagulation Inhibitors

C. Anticoagulants

D. Fibrinolytics

E. Antifibrinolysis

F. Thrombin


Chapter 4 Pathology and Pathogenesis

I. Introduction

II. The Subarachnoid Space, Pia-arachnoid, Arachnoid Villi, and Cerebrospinal Fluid

A. Subarachnoid Space and Pia-Arachnoid

B. Arachnoid Villi

C. Cerebrospinal Fluid

III. Cytopathology of Cerebrospinal Fluid and Subarachnoid Hemorrhage

A. Cellular Responses

B. Red Blood Cell Clearance

IV. Arterial Changes in Vasospasm

A. Systemic Arterial Response to Injury

B. Morphometry of Vasospasm

C. Pathology of Arteries in Vasospasm

D. Changes in Arterial Innervation

E. Arterial Wall Barrier Disruptions

F. The Functional Significance of Morphologic Changes

G. Blood-Brain Barrier

V. Changes in Composition of Cerebrospinal Fluid, Blood, and Adjacent Tissues

A. Cerebrospinal Fluid

B. Changes in Blood Serum and Plasma

C. Changes in Vessel Wall, Leptomeningeal Cells, Brain, and Clot

VI. Cerebral Infarction from Vasospasm

A. Physiology of Aneurysmal Rupture and Vasospasm

B. Impairment of Autoregulation

C. Cerebral Edema

D. Cerebral Volume Changes

E. Cerebrospinal Fluid and Intracranial Pressure

F. Cerebral Blood Flow

G. Cerebral Metabolism

H. Histopathology

I. Clinical Studies of Infarction


Chapter 5 Radiology

I. Introduction

II. Angiography

A. Definition and Classification of Angiographic Vasospasm

B. Method of Diagnosis

C. Clinical Series

D. Very Delayed Vasospasm

E. Nonaneurysmal Vasospasm

F. Acute Angiographic Vasospasm

G. Vertebrobasilar Vasospasm

H. Operation and Vasospasm

I. The Venous System and Vasospasm

J. Automated Assessment

K. Mean Transit Time and the Intraparenchymal Circulation

L. Extradural Vasospasm

III. CT Scan

A. Early Demonstration of Subarachnoid Hemorrhage

B. Duration of Subarachnoid Hemorrhage on CT Scan

C. Relationship of Subarachnoid Hemorrhage on CT Scan to Angiographic Vasospasm and Infarction

D. Relationship of Blood on CT Scan to Hydrocephalus

E. Computed Tomographic Prognostic Factors for Poor Outcome

F. Computed Tomographic Demonstration of Ischemic and Hemorrhagic Infarction

G. Quantification of Degree of Subarachnoid Hemorrhage on CT Scan

H. Time Course of Low-Density Areas on CT Scan

I. Demonstration of Rebleeding on CT Scan

J. Effect of Nimodipine on Infarction

K. The Basal Cisterns in Subarachnoid Hemorrhage

L. Computed Tomographic Findings in Patients Dying Early from Subarachnoid Hemorrhage

M. Seizures

N. Coiling of Aneurysms

O. Contrast Enhancement

P. Computed Tomographic Angiographic Direct Demonstration of Vasospasm

IV. Transcranial Doppler Ultrasonography

A. History

B. Technical Aspects

C. Normal Values and Indices

D. Time Course of Velocity Changes

E. Velocity Changes and Angiographic Vasospasm

F. Velocity Changes and Distal Angiographic Vasospasm

G. Velocities, Delayed Ischemic Deficits, and Infarction in Clinical Studies

H. Clinical Factors Affecting Velocities

I. Effect of Age on Velocities

J. Velocities and Blood Pressure

K. Velocities and Physiological Parameters

L. Velocity Changes during Aneurysmal Rupture

M. Velocity Changes during Brain Death

N. Velocity Changes Correlated with Angiographic Diameter

O. Velocity Changes Correlated with Single Photon Emission Computed Tomography Studies

P. The Effect of Hyperosmotic Agents on Velocities

Q. The Transient Hyperemic Response

R. Intracranial Pressure and Velocities

S. Cerebral Blood Flow and Velocities

T. Velocities in Traumatic Subarachnoid Hemorrhage

U. Velocities and Angioplasty

V. The Clinical Value of Transcranial Doppler Ultrasonography

V. Magnetic Resonance Imaging

A. Basic Mechanisms

B. Clinical Series

C. Imaging Techniques

D. Diffusion-Weighted Imaging

E. Magnetic Resonance Spectroscopy

F. Magnetic Resonance Angiography

G. Advantages and Disadvantages

VI. Positron Emission Tomography

A. Changes with Vasospasm

B. Flow and Metabolism with Infarction

C. Oxygen Delivery

VII. Single Photon Emission Computed Tomography

A. History

B. Technique

C. Findings in Vasospasm

D. Activation Studies (Induced Parenchymal Vasodilation)

E. Postoperative Changes

F. Angioplasty

G. Attempted Quantification

H. Eclampsia

I. Comparative Studies

VIII. Cerebral Blood Flow Studies

A. 133Xe Studies

B. Xe CT Studies


Chapter 6 Pharmacology

I. Introduction

II. General Considerations

A. Experimental Variables

B. Hypoxia

III. Neurogenic Factors

A. Adrenergic Nerves

B. Cholinergic Nerves

C. Intracerebral Pathways

D. Effect of Subarachnoid Hemorrhage on Nerves

E. Effect of Electrical Stimulation

IV. Biogenic Amines

A. Definitions

B. Catecholamines

C. Norepinephrine as a Potential Spasminogen

D. Human Studies

E. Serotonin (5-Hydroxytryptamine)

F. Acetylcholine

G. Histamine

V. Neuropeptide Transmitters

A. Tension Experiments

B. Effects of SAH

C. Intracisternal Injections

D. Human Studies

E. Bradykinin

VI. Eicosanoids

A. Biochemistry

B. Prostaglandins

C. Thromboxanes

D. Leukotrienes

VII. Endothelin

A. History

B. Basic Science

C. Putative Spasmogens

D. Vasoconstriction

E. Pharmacological Interactions

VIII. Blood and Cerebrospinal Fluid

A. Circulating Factors

B. Blood Derivatives

C. Studies of CSF after Subarachnoid Hemorrhage

D. Thrombin

E. Fibrin and Fibrinogen Degradation Products

F. Bilirubin

G. Iron

H. Adenosine Triphosphate

IX. Hemoglobin

A. Overview with Subarachnoid Hemorrhage

B. Biochemistry

C. Heme, Hemin, and Hematin

D. In Vitro Studies

E. Hemoglobin and Isolated Cells

F. In Vitro Long-Term Studies

G. Spectrophotometric Experiments

H. Attempted Reversal of Hemoglobin-Induced Vasoconstriction

I. Hemoglobin Interactions

J. Ultrapure Hemoglobin

K. Heme Oxygenase

L. Hemoglobin and Arterial Wall

M. Endothelin and Hemoglobin

N. Endothelium-Derived Hyperpolarizing Factor

X. Nitric Oxide

A. Nitric Oxide as a Vasodilator

B. Injury Induced by Nitric Oxide

C. Nitric Oxide Synthase

D. Nitric Oxide Synthase Inhibitors

XI. Nitrovasodilators

A. Mechanisms of Action

B. Animal Models of Subarachnoid Hemorrhage

C. Intrathecal Nitrovasodilators

D. Effect on Vascular Smooth Muscle Cells

XII. Free Radicals

A. Oxygen and Free Radicals

B. Superoxide Radical

C. Hydroxyl Radical

D. Nitric Oxide Radical

E. Free Radicals and Stroke

F. Production of Vasospasm by Free Radicals

G. Effect of Free Radicals on Vascular Smooth Muscle

H. Lipid Peroxidation

I. Amino Steroids

J. Oxidation of Hemoglobin

K. Free Radical Scavengers

XIII. Recent Novel Pharmacological Approaches


Chapter 7 Structure, Physiology, and Biochemistry of Vascular Smooth Muscle

I. Introduction

II. Tension, Tone, and Work

III. Structural Components

A. Blood Vessel Walls

B. Vascular Endothelium

C. Vascular Smooth Muscle Cells

IV. Actin and Myosin

A. Sliding Filament Theory

B. Structure and Interactions

C. Rigor and Latch States

V. Modulating Proteins

A. Calmodulin

B. Caldesmon

C. Tropomyosin

D. Calponin

VI. Relaxation

A. General

B. Phosphatases

VII. Calcium

A. Regulation of Calcium in Vascular Smooth Muscle

B. Force and Sarcoplasmic Calcium

C. Plasmalemma and Calcium Control

D. Sacroplasmic Reticulum and Calcium Control

E. Calcium and Hemolysate

F. Calcium and Oxyhemoglobin

VIII. Enzymes, Receptors, and Messenger Systems

A. Myosin Light Chain Kinase

B. Protein Kinase C

C. Tyrosine Kinase

D. Mitogen-Activated Protein Kinase

E. G Proteins

F. Rho A

G. Phosphatidylinositol Cascade and Diacylglycerol

H. Inositol Phosphates and Hemoglobin



IX. Membrane Potential

A. General

B. Calcium Channels

C. Potassium Channels

X. Acidosis and Hypoxia

A. Acidosis

B. Hypoxia

XI. Growth and Contraction

XII. Metabolism

A. General

B. Arterial Metabolism after Experimental Subarachnoid Hemorrhage


Chapter 8 Medical Aspects of Vasospasm

I. Introduction

II. Diagnosis

A. Symptoms

B. Signs

C. Laboratory Findings

III. Differential Diagnosis

A. Respiratory Complications

B. Electrolyte Disorders

C. Infection and Fever

D. Cardiac Complications

E. Hypertension and Hypertensive Encephalopathy

F. Seizures

G. Rebleeding

H. Gastrointestinal Complications

I. Endocrine

J. Metabolic

K. Intracranial Hypertension and Hydrocephalus

IV. Prophylaxis

A. Calcium Antagonists

B. Models Using Calcium Antagonists

C. Avoidance of Antifibrinolytics

D. Avoidance of Dehydration

E. Optimal Hematocrit

F. Sickle Cell Disease

G. Avoidance of Hypotension and Hypertension

H. Salicylates

I. Cisternal Drainage

J. Fibrinolytics

V. Management of Delayed Ischemic Deficit

A. Monitoring for Delayed Ischemic Deficit

B. Immediate Actions on Detection of Delayed Ischemic Deficit

C. Likelihood of Delayed Ischemic Deficit Developing

D. Delayed Ischemic Deficit after Coiling

E. Neuroprotective Strategies

VI. Therapy

A. Hypertension

B. Hypervolemia

C. Hemodilution


E. Cerebral Blood Flow

F. Clinical Series

G. Complications

H. Fluids

I. Models of Hypertension and Hypervolemia

J. Assessing Cardiac Function

K. Reducing Intracranial Pressure

L. Respiratory Support

M. Angioplasty

N. Nitrovasodilator Therapy

VII. Randomized Clinical Trials

VIII. The Art of Treatment


Chapter 9 Nonruptured Aneurysm Vasospasm

I. Postoperative Cases

A. Pituitary Tumors

B. Other Tumors

II. Vascular Lesions

A. Arteriovenous Malformations

B. Unruptured Aneurysms

C. Aneurysms with Very Delayed Onset of Vasospasm

D. Benign Perimesencephalic Hemorrhage

III. Head Injury

A. Clinical Series

B. Experimental

IV. Infections

V. Eclampsia

A. Magnesium Sulfate

B. Pathology

C. Angiography

D. Transcranial Doppler Sonography

E. Magnetic Resonance Studies

VI. Migraine Headaches as a Vasoconstrictor Phenomenon

VII. Coronary Artery Vasospasm


Chapter 10 Surgical Aspects of Vasospasm

I. Surgical Trauma Mimicking or Aggravating Vasospasm

II. Clot Removal at Surgery

A. Clinical Series

B. Models of Clot Removal

III. Timing of Surgery and Vasospasm

A. Optimal Timing

B. Treatment in the Presence of Established Vasospasm

IV. Cisternal Drainage

V. Fibrinolytic Therapy and Surgery


Chapter 11 Animal Models

I. Introduction

II. Models In Vitro

III. Acute Effects of SAH versus VSP

IV. Species Differences

V. Considerations in the Conduct of Animal Studies

VI. Creation of SAH

VII. Specific Animal Models

A. Mouse

B. Rat

C. Cat

D. Rabbit

E. Dog

F. Pig

G. Nonhuman Primate

H. Other

VIII. Ethical Considerations


Chapter 12 Molecular Biology and Genetics

I. Introduction

II. Genetic Predisposition to Vasospasm

III. Molecular Biological Techniques

A. Transgenic and Knockout Mice

B. Screening for Changes in Gene Expression

IV. Changes in Regulatory Mechanisms of Smooth Muscle Contraction

A. Smooth Muscle Contraction

B. Contractile Proteins

C. Protein Kinase C

D. Calpains

E. Tyrosine Kinases

F. Mitogen-Activated Protein Kinases

G. Other Mechanisms

V. Changes in Smooth Muscle Relaxation Mechanisms

VI. Changes in Endothelium-Regulated Mechanisms

VII. Changes in Genes That May Influence Vasospasm

A. Heme Oxygenases

B. Immediate Early Genes

C. Inflammation

D. Remodeling, Fibrosis, Proliferation, and Phenotype Change

E. Apoptosis

VIII. Microvascular Spasm

IX. Changes in the Brain

X. Gene Therapy




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© Academic Press 2001
Academic Press
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About the Author

R. Macdonald

Affiliations and Expertise

University of Chicago, Illinois, U.S.A.

Bruce Weir

Affiliations and Expertise

Brain Surgery Research Institute, University of Chicago, Illinois, U.S.A.


"...this is indeed a magnum opus and would play an important factor in finding a remedy for vasospasm...I would add that it is a must read for any neuroscientist currently undertaking research into the subject and indeed would be a valuable background text for any neurosurgeon in training"-JOURNAL OF NEUROLOGY, NEUROSUREGERY,AND PSYCHIATRY (2003) @qu:"Seldom published is a volume as remarkable as Cerebral Vasospasm. ...It provides a comprehensive review of the topic from what seems to me to be every conceivable angle. ...The wisdom of the authors is truly profound and they share it generously with the reader. ...Its in-depth treatment of all aspects of cerebral vasospasm, coupled with a relatively reasonable price, make it a must-have for anybody involved in the investigation, be it clinical or laboratory, of this interesting problem." @source:--Ian B. Ross, University of Neurosurgeons, in the JOURNAL OF NEUROSURGERY (February 2002) @qu:"This book has an easy to follow format and is accessible to those reviewing it as a comprehensive reference. The book will be useful to physiologists, residents, neurologists and neurosurgeons. ...This is a welcome, comprehensive review of the basic clinical aspects of cerebral vasospasm. It will be a standard by which all future books on cerebral vasospasm will be judged. There are no current references like this book." @source&#;Joseph J. Grenier, University of Illinois at Chicago College of Medicine for DOODY'S PUBLISHING (2002) @qu:"...the most complete textbook on this topic. ...This book is an extremely valuable synthesis of information on cerebral vasospasm and cerebral arterial pathophysiology. It is meant not only for neurosurgeons who would like to refresh their general knowledge of the topic, by using this book as a dictionary; it is also suitable for physicians who have less knowledge than specialists about the pathogenesis, prevention, and management of this disease." @source:--Jean-Pierre Castel, University Hospital Pellegrin, France, in NEW ENGLAND JOURNAL OF MEDICINE (October 2001)