Summary:We investigated the neuroprotective potential of MK-801 (dizocilpine), a noncompetitive N-methyl-D aspartate (NMDA) antagonist, in the setting of three 5-min periods of global cerebral ischemia separated by I-h intervals in halothane-anesthetized rats. Each isch emic insult was produced by bilateral carotid artery oc clusions plus hypotension (50 mm Hg). Brain temperature was maintained at normothermic levels (36.5-37.0°C) throughout the experiment. MK-801 (3 mg/kg) (n = 6) or saline (n = 6) was injected intraperitoneally 45 min fol lowing the end of the first ischemic insult. Following 7-day survival, quantitative neuronal counts of perfusion fixed brains revealed severe ischemic damage in hippo campal CAl area, neocortex, ventrolateral thalamus, and striatum of untreated rats. By contrast, significant pro tection was observed in MK-801-treated rats. In area CAl of the hippocampus, numbers of normal neurons were increased 11-to 14-fold by MK-801 treatment (p < 0.01).
925showed almost complete histologic protection, and neo cortical damage was reduced by 71% (p < 0.01). The degree of MK-801 protection of striatal neurons was less complete than that seen in other vulnerable structures, amounting to 63% for central striatum (p = 0.02, Mann Whitney U test) and 48% in the dorsolateral striatum (NS). A repeated-measures analysis of variance demon strated a highly significant overall protective effect of MK-801 treatment (FI 10 = 37.2, P = 0.0001). These find ings indicate that exc'itotoxic mechanisms play a major role in neuronal damage produced by repeated ischemic insults and that striking cerebroprotection is conferred by MK-801 administered following the first insult in animals with cerebral normothermia. NMDA antagonists may prove useful in patients at risk of repeated episodes of cerebral ischemia.