Intra-Arterial Nimodipine in Progressive Postpartum Cerebral Angiopathy

Klein, Matthias; Fesl, Gunther; Hw, Pfister; Straube, Andreas; Brückmann, H.; La, Hoffmann; Pfefferkorn, Thomas

doi:10.1111/j.1468-2982.2008.01728.x

Cited by 19 publications

(28 citation statements)

References 16 publications

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“…Taking into account that clinical presentation of RCVS is common in pregnancy, we believe that it is largely underdiagnosed owing to limited use of vessel imaging. Angiographic findings are also not specific for RCVS and can be seen in cerebral vasculitis, a condition, which is at least 100-times less frequent than RCVS [71]. Lumbar puncture can be used to exclude aneurysmal bleeding and vasculitis.…”

Section: Reversible Cerebral Vasoconstriction Syndromementioning

confidence: 98%

Stroke in pregnant and postpartum women

Sidorov

Feng

Caplan

2011

Expert Review of Cardiovascular Therapy

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Ischemic infarcts and hemorrhages are uncommon but dangerous complications of pregnancy. Their etiology is related to physiological changes during pregnancy. The majority of strokes are seen in the third trimester and postpartum and are etiologically related to three conditions: reversible cerebral vasoconstriction syndrome, preeclampsia/eclampsia and cerebral venous thrombosis. The first two conditions are etiologically connected and can lead to ischemic and hemorrhagic events, whereas cerebral sinus thrombosis is mainly related to hypercoagulation and causes venous infarcts and brain hemorrhages. MRI and CT scans are safe to use for diagnosis of stroke in pregnancy, although use of iodine-based contrast may affect thyroid function of the neonate. Management of stroke in pregnancy is specific to cause and depends on management of blood pressure and delivery in preeclampsia/eclampsia, expected management or calcium channel blockers in reversible cerebral vasoconstriction syndrome, and anticoagulation for cerebral sinus thrombosis.

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Section: Reversible Cerebral Vasoconstriction Syndromementioning

confidence: 98%

Stroke in pregnant and postpartum women

Sidorov

Feng

Caplan

2011

Expert Review of Cardiovascular Therapy

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“…In severe cases, intra-arterial therapy may be considered. The use of intra-arterial nimodipine, papaverine or the phosphodiesterase inhibitore milrinone has been reported with googd results, although experience is limited to case reports [150][151][152].…”

Section: Treatment Of Non Sah Vasospasmmentioning

confidence: 99%

Cerebral vasospasm: a review of current developments in drug therapy and research

Archavlis¹,

Nievas²

2013

J Pharm Technol Drug Res

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In this manuscript a comprehensive coverage of recent developments in the drug therapy of vasospasm while providing the background information that neuroscientists need to understand its rationale. The range of new agents available for treatment of cerebral vasospasm is expanding rapidly along with rapid advances in pharmacology and physiology that are uncovering the mechanisms of this disease. Although there are many publications for treatment of cerebral vasospasm, most are focusing on different aspects of vasospasm treatment and many have limited value due to insufficient quality. Moreover, the complexity of this, in many cases deleterious condition, is enormous and the information needed to understand drug effects is accordingly often not readily available in a single source. A number of pharmacological and medical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Curent research efforts promise the eventual production of new medical therapies. At last, recommendations for the use of different treatment stages based on currently available clinical data are provided.

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“…Intravenous nimodipine has been used successfully in this setting. 7,8 If parenteral CCBs are used, the patient should be treated until angiographic abnormalities resolve. If oral CCBs are used, the patient should continue to receive therapy until 4 weeks after angiographic abnormalities and/or symptoms have resolved because elevated transcranial Doppler velocities have been shown to persist and peak up to 3 weeks after the last TCH.…”

Section: Which One Of the Following Is The Most Appropriate Treatmentmentioning

confidence: 99%

55-Year-Old Man With Thunderclap Headache

Zarkou

Dilli

Dodick

2010

Mayo Clinic Proceedings

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A 55-year-old man who was in his usual state of good health jogged a short distance to his car as he was leaving a restaurant. As he sat down in the driver's seat, he experienced the sudden onset of a severe left occipital headache that was at maximal severity at onset and was associated with nausea and an episode of emesis. He experienced no photophobia, phonophobia, neck stiffness, or focal neurologic symptoms or signs. He had no history of headache. He presented to the emergency department at an outside institution about 20 minutes after onset. Findings on neurologic examination were normal, and he was not hypertensive.

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Intra-Arterial Nimodipine in Progressive Postpartum Cerebral Angiopathy

Cited by 19 publications

References 16 publications

Stroke in pregnant and postpartum women

Stroke in pregnant and postpartum women

Cerebral vasospasm: a review of current developments in drug therapy and research

55-Year-Old Man With Thunderclap Headache

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