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Acute vasoconstriction after subarachnoid hemorrhage

J B Bederson1, A L Levy, W H Ding

  • 1Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.

Neurosurgery
|March 3, 1998
PubMed
Summary

Acute vasoconstriction after subarachnoid hemorrhage (SAH) significantly reduces cerebral blood flow (CBF) and predicts mortality. This constriction is independent of intracranial pressure and linked to elevated glutamate, suggesting it directly causes ischemic brain injury.

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Area of Science:

  • Neuroscience
  • Cerebrovascular Research
  • Pathophysiology of Subarachnoid Hemorrhage

Background:

  • Subarachnoid hemorrhage (SAH) can cause decreased cerebral blood flow (CBF) and ischemia due to acute microvascular constriction.
  • CBF is also influenced by intracranial pressure (ICP) and cerebral perfusion pressure (CPP).

Purpose of the Study:

  • To assess the significance of acute vasoconstriction after SAH.
  • To determine the relationship between vasoconstriction and changes in CBF, ICP, CPP, and extracellular glutamate concentrations.

Main Methods:

  • Endovascular filament technique to induce SAH in rats.
  • Measurement of CBF, ICP, and CPP post-SAH and correlation with mortality.
  • Vascular measurements (circumference, wall thickness) and correlation with physiological parameters.

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  • Measurement of extracellular glutamate concentrations via microdialysis and HPLC.

    • Main Results:

    • Reduced CBF (<40% baseline) accurately predicted 24-hour mortality in lethal SAH.
    • Acute vasoconstriction (smaller vessel circumference) was observed in lethal SAH, independent of ICP and CPP.
    • Elevated extracellular glutamate (600% baseline) in lethal SAH was inversely correlated with CBF.

    Conclusions:

    • Acute vasoconstriction following SAH is a key factor in decreased CBF and ischemic brain injury.
    • Vasoconstriction is associated with poor outcomes, increased hemorrhage size, and elevated glutamate levels.
    • Targeting acute vasoconstriction pharmacologically may improve CBF and patient outcomes after SAH.