Prophylactic intra-arterial administration of fasudil hydrochloride for vasospasm following subarachnoid haemorrhage.

PURPOSE: We evaluated patients treated with prophylactic intra-arterial administration of fasudil hydrochloride (IAF) after subarachnoid haemorrhage (SAH). MATERIALS AND METHODS: Between August 1998 and December 2012, 92 patients with aneurysmal SAH were treated with IAF for angiographic vasospasm without ischemic symptoms after their follow-up angiography. Patients comprised 50 women and 42 men, aged 24-83 (mean 56.6) years. IAF consisted of 15 mg of fasudil hydrochloride dissolved in 20 ml physiological saline and injected through a catheter during approximately 15 min, after diagnostic angiography. The clinical outcome was evaluated using the Glasgow Outcome Scale (GOS) at discharge and ischemic lesions resulting from vasospasm were assessed on computed tomography (CT) scan at discharge. RESULTS: Forty-eight patients underwent surgical clipping and 44 patients underwent endovascular coiling. Angiographic improvement was observed in all patients (100 %). At discharge, 76 (83.0 %) of 92 patients showed good recovery on GOS. Nine patients developed progression of delayed ischemic neurological deficits (DIND) and three of these patients had ischemic lesions on CT scans. No patient had any significant changes in vital signs or any other adverse effects resulting from IAF. CONCLUSION: IAF therapy was safe and effective for patients with vasospasm following SAH. Prophylactic IAF therapy may prevent symptomatic vasospasm.

Coil Embolization of Cerebral Aneurysms. Experience with IDC and GDC.

SUMMARY: Coil embolization was performed in 86 cerebral aneurysm patients using two types of detachable platinum coils, IDC (Interlocking detachable coil) and GDC (Guglielmi electrical detachable coil). Results of IDC and GDC were compared. The occlusion rate of the aneurysm sac was similar. Coil compaction occurred frequent and early in cases with GDC. As clinical outcome, 94% of the patients in both group obtained good results. No bleeding or rebleeding occurred in the follow-up with IDC or GDC.

[A case of hypertrophic spinal pachymeningitis].

A 79-year-old woman was admitted to our hospital complaining of gait disturbance. At the time of admission, she had incomplete monoparesis of the left lower extremity, with a sensory level of T6. MR images showed a thickened dura at the C6-T4 vertebral levels. The thickened dura showed low intensities on T1- and T2-weighted images, and was homogeneously enhanced by Gd-DTPA. Hypertrophic spinal pachymeningitis (HSP) was suspected, and laminectomy was performed from T2 to T3. The thickened dura was found and partially resected. Microscopically, the diagnosis was HSP. Steroid therapy was initiated after surgery. Postoperatively, the patient's physical status and radiographic images improved. The etiology of HSP is not clear in most cases. It is difficult to diagnose radiographically, although MR imaging can help differentiate it from other disorders. T1- and T2-weighted images of HSP show low intensities, and the T1-weighted image is homogeneously enhanced by Gd-DTPA. Treatment is early decompressive surgery with possible excision of the involved dura. Steroid therapy was effective in our case.

Failure of FK-506, a new immunosuppressant, to prevent cerebral vasospasm in a canine two-hemorrhage model.

In order to clarify the possible role of immunological reaction in the pathogenesis of cerebral vasospasm, the authors examined the prophylactic effect of the immunosuppressant agents FK-506 and cyclosporin A on chronic vasospasm in a canine two-hemorrhage model. While a mean constriction of the basilar artery to 81.0% +/- 4.0% (+/- standard error of the mean) occurred on Day 2 and to 63.8% +/- 3.5% on Day 7 in the untreated group, constriction to 77.9% +/- 3.4% on Day 2 and 62.8% +/- 3.0% on Day 7 was demonstrated in the FK-506-treated group (difference not significant). This tendency was also noted in the cyclosporin A-treated group, with basilar artery constriction to 81.8% +/- 3.7% and 56.3% +/- 2.7%, respectively (difference not significant). The histological changes of the basilar artery, including corrugation of the elastic lamina, detachment of endothelial cells, and vacuolar formation in the smooth-muscle layer were not different in the two treated groups and the one control group. Since these immunosuppressant agents are known to inhibit the release of interleukin-2 (IL-2), the level of IL-2 was examined in the cerebrospinal fluid of patients with cerebral vasospasm. While interleukin-1 gradually increased in level as time passed, the level of IL-2 was consistently low during the course of the study, indicating less participation of IL-2 in the pathogenesis of cerebral vasospasm. This clinical observation matched the experimental results. The authors conclude that cell-mediated immunoreaction, initiated mainly by IL-2, plays little role in the pathogenesis of cerebral vasospasm.