The Effects of Proanthocyanidin on Vasospasm After Experimental Subarachnoidal Hemorrhage in Rats.

AIM: Delayed ischemic neurological deficit (DIND) and cerebral vasospasm (CV) remain the most common and debilitating neurological complications following aneurysmal subarachnoidal hemorrhage (SAH). Many reports demonstrate the importance of proanthocyanidins (PR) on the vascular system, including endothelium-dependent relaxation of blood vessels. These effects of PR on the cerebral vascular system were examined in this study. < p < MATERIAL and METHODS: Fifty-two adult Sprague-Dawley male rats were used for the experimental double hemorrhage model. They were divided to control, sham, pre- and post-interventional treatment groups. 100 mg/kg PR was administered for the treatment for respect to groups. Basilar artery diameter (BAD) and arterial wall thickness were measured and the apoptosis ratio of the endothelial cells was calculated. Arterial walls were examined electron microscopically (EM). RESULTS: There were significant differences between the groups except control and pre-SAH (p=0.37) and post-SAH and pre- SAH groups (p=0.15) with respect to BAD. According to arterial wall thickness, apoptosis ratio, and grading, there were significant differences between the groups except control and pre-SAH (p=0.85, p=0.49 and p=0.18 respectively) and SAH and post-SAH (p=0.08, p=0.21 and p=0.24 respectively) groups. EM findings revealed that pro-apoptotic and pro-necrotic degenerated endothelial cells with seldom vacuolization in post-SAH treatment group which were more serious in SAH group. CONCLUSION: Pre-SAH administration of PR induces better vasodilatation and protection of basilar artery (BA) from vasospasm (VS), which could yield neuroprotective and vasodilatator effects. In addition, PR appears to be involved in relieving oxidative damage, with an antioxidant-antiapoptotic-antinecrotic effect that may contribute to vascular dilation.

The Relationship of the Vertebral Artery with Anatomical Landmarks in the Posterior Craniovertebral Junction of Fresh Human Cadavers in the Turkish Population.

AIM: Surgical anatomy concerning the posterior craniovertebral region in fresh human cadavers was studied to provide most accurate information for the surgical approach. MATERIAL AND METHODS: In thirty-two fresh human cadavers, the distance from the posterior tubercle to the sulcus of vertebral artery (VA), the thickness and length of the third segment of VA (V3), the distance of C1/C2 facet to V3, the length, height and shape of the C2 ganglion to the neighboring structures, the distance from medial border of C1 lateral mass to dura mater, the distance of the transverse process of atlas to mastoid tip, the thickness of C1 posterior arcus were measured. RESULTS: There were variations of sulcus of VA in 14 of 32 cadavers (43.7%), the right VA was larger in 23 cadavers (71.8%). The ganglion was found over the C1 lateral mass screw entry point in 45 of 64 ganglions (70.31%) and below the screw entry point in 19 of 64 ganglions (29.69%). The distance of the medial border of the C1 lateral mass to dural tube was 3.81±0.55 mm at the right side and 3.91±0.59 mm at the left. The thickness of C1 posterior arch was 3.73±0.75 mm at the right side and 3.75±0.77 mm at the left. The mean distance from the transverse process of C1 to the mastoid tip was 15.82±4.49 mm at the right side and 15.46±4.38 mm at the left. CONCLUSION: This is the most comprehensive and only fresh cadaver study about this region in the literature.

Brucellar discitis as a cause of lumbar disc herniation: a case report.

Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or through contact with infected animals. Spinal involvement is one of the most important complications and the lumbar area is the most frequently affected site. Among the neurological consequences, nerve root compression can be a result of epidural abscess, granuloma or discitis secondary to vertebral body involvement. In this case report we present a 50-year-old male patient with brucellar discitis without spondylitis which caused lumbar disc herniation. We want to emphasize that discitis should also be considered in differential diagnosis of nerve root compression in suspected cases.

Transforaminal epidural steroid injection via a preganglionic approach for lumbar spinal stenosis and lumbar discogenic pain with radiculopathy.

BACKGROUND: Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (CLBP) with various degrees of success. AIM: We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs) via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. MATERIALS AND METHODS: We analyzed the data of 40 patients (February 2008 and April 2009) with the diagnosis of CLBP and treated by fluoroscopically guided TFESIs via a preganglionic approach. Patients were followed-up at one month (short term), six months (midterm) and one year (long term) after injections. Follow-up data collection included the Visual Numeric Pain Scale (VNS) and North American Spine Society (NASS) patient satisfaction scores. RESULTS: The mean age of the patients was 59.87 +/- 15.06 years (range 30 - 89 years, 25 women). Average follow-up period was 9.22 +/- 3.56 months. Statistically significant differences were observed between the pre-procedure and post-procedure VNSs (P < 0.01, Pearson Correlation Test). Improvements in VNS scores were correlated with improvements in the NASS scores. When the VNS scores were evaluated with respect to the age of patient, level numbers, gender, pre-procedure symptom duration and pre-procedure VNS, no significant differences were found (P < 0.05, linear regression test). At short term evaluation in post treatment (one month), 77.78 % of patients were found to have a successful outcome and 22.22 % were deemed failures. Overall patient satisfaction was 67.23 % in the midterm period. Additionally, 54.83 % of patients (N/n: 15/8) had a successful long-term outcome at a follow-up of one year. CONCLUSION: Our data suggest that fluoroscopically guided TFESIs via a preganglionic approach, in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy, has effective outcome and patients responding to injection have significantly lower post-injection pain scores.

The preventive effect of mexiletine on cerebral ischemic injury following experimental middle cerebral artery occlusion.

AIM: Previous studies demonstrated that mexiletine has some important features in the prevention of ischemic brain injury such as sodium and calcium canal blockage and free radical occurrence. Our aim was to investigate the effects of mexiletine on ischemic brain injury. MATERIAL AND METHODS: Experiments were performed on 30 adult male Sprague- Dawley rats (285-425 g). Left middle cerebral artery occlusion following microcraniectomy and simultaneous bilateral carotid artery occlusion were performed. Three different treatments were included in this study: (a) "naïve" control group (no drug applied; n = 10); (b) "sham surgery" control group (only saline was applied; n = 10); and a (c) "treatment group (n = 10) where mexiletine was applied. After 24 h from ischemic insult, all rats were decapitated and prepared for immunocytochemical and histopathological analyses. Cerebral infarct volumes were calculated and compared using ANOVA and a Post- Hoc Bonferroni test in each group statistically. RESULTS: The results showed statistically significant differences between the treatment (81.98 +/- 12.58 mm?), control (121.57 +/- 11.41 mm?) and sham (116.08 +/- 12.36 mm?) groups (p < 0,0001), respectively. CONCLUSION: Mexiletine should be considered as an alternative medication for prevention and treatment of ischemic brain injury due to its multipotent effects.