Vasoespasmo cerebral

Salles, Antonio A. F. de

doi:10.1590/S0004-282X1987000300014

Resumos

Vasoespasmo cerebral ocorre em patologias como enxaqueca, hemorragia subaracnóidea, trauma de crânio, após isquemia e/ou hipoxia. A fisiopatologia do vasoespasmo cerebral nestas patologias não está completamente desvendada. Neste artigo são analisados os fatores neuroquímicos e morfológicos responsáveis pelo controle circulatório cerebral. As alterações circulatórias que seguem a hemorragia subaracnóidea são utilizadas como exemplo. Conclui-se que fatores bioquímicos, fisiológicos e morfológicos são responsáveis pelas manifestações vasculares que ocorrem após a hemorragia subaracnóidea. Alternativas de tratamento do vasoespasmo cerebral são discutidas.

Cerebral vasospasm is an important component of pathological entities such as migraine, subarachnoid hemorrhage (SAH), head trauma, post cerebral ischemia and/or hypoxia. The mechanisms underlying cerebral vasospasm in these diseases are not completely understood. Neurochemical and morphological factors involved in the cerebral circulation control are reviewed in this article. The circulatory changes observed after subarachnoid hemorrhage are taken as a model. It is concluded that multiple biochemical, physiological and morphological factors are involved in the cerebral vascular responses after SAH. Possible treatment alternatives for cerebral vasospasm based on its etiology are discussed.

Cerebral vasospasm

Vasoespasmo cerebral

Antonio A. F. de Salles

M. D., Ph. D. - Department of Physiology, Medical College of Virginia

SUMMARY

Cerebral vasospasm is an important component of pathological entities such as migraine, subarachnoid hemorrhage (SAH), head trauma, post cerebral ischemia and/or hypoxia. The mechanisms underlying cerebral vasospasm in these diseases are not completely understood. Neurochemical and morphological factors involved in the cerebral circulation control are reviewed in this article. The circulatory changes observed after subarachnoid hemorrhage are taken as a model. It is concluded that multiple biochemical, physiological and morphological factors are involved in the cerebral vascular responses after SAH. Possible treatment alternatives for cerebral vasospasm based on its etiology are discussed.

RESUMO

Vasoespasmo cerebral ocorre em patologias como enxaqueca, hemorragia subaracnóidea, trauma de crânio, após isquemia e/ou hipoxia. A fisiopatologia do vasoespasmo cerebral nestas patologias não está completamente desvendada. Neste artigo são analisados os fatores neuroquímicos e morfológicos responsáveis pelo controle circulatório cerebral. As alterações circulatórias que seguem a hemorragia subaracnóidea são utilizadas como exemplo. Conclui-se que fatores bioquímicos, fisiológicos e morfológicos são responsáveis pelas manifestações vasculares que ocorrem após a hemorragia subaracnóidea. Alternativas de tratamento do vasoespasmo cerebral são discutidas.

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1. ALEXANDER III, E.; BLACK, P.M.C.L.; LISZCZAK, T.M.; ZERVAS, N.T. - Delayed CSF lavage for artériographie and morphological vasospasm after experimental SAH. J. Neurosurg 63:949, 1985.
2. ALKSNE, J.F.; GREENHOOT, J.H. - Experimental catecholamine-induced cerebral vasospasm: myonecrosis in vessel wall. J. Neurosur 41:440, 1974.
3. ALLEN, G.S. - Cerebral arterial spasm: a discussion of present and future research. Neurosurgery 1:142, 1977.
4. ALLEN, G.S.; AHN, H.S.; PREZIOSI, T.J. et al. - Cerebral arterial spasm - a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N. Engl. J. Med. 308:619, 1983.
5. BAUMBACH, G.L.; HEISTAD, D.D. - Effect of sympathetic stimulation and changes in arterial pressure on segmental resistance of cerebral vessels in rabbits and cats. Cir. Res. 52:527, 1983.
6. BEKS, J.W.F. - Cerebral vasospasm and increased intracranial pressure. In R.H. Wilkins (ed.) : Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 412.
7. BERRIDGE, M.J. - Cellular control through interaction between nucleotides and calcium. Advances in Cyclic Nucleotide and Protein Phosphorylation Res. 17:329, 1984.
8. BLAUMANIS, O.R.; GRADY, P.A. - Experimental cerebral vasospasm: resolution by chloropromazine. Surg. Neurol. 17:263, 1982.
9. BURNSTOCK, G. - Nervous control of cerebral blood vessels: a new hypothesis of the mechanism underlying migraine. In F.C. Rose & K.J.Ailkha (eds.): Progress in Migraine Research 1. London, Pitman Press, 1981. p. 17.
10. BUSIJA D.W. - Role of prostaglandins in modulating synmpathetic vasoconstriction in the cerebral circulation in anesthetized rabbits. JCBFM 17:24, 1985.
11. CLARK, C. - Turbulent velocity measurements in a model of aortic stenosis. J. Biomech. 9:677, 1976.
12. CONTI, M.A.; ADELSTEIN, R.S. - Phosphorylation by cyclic adenosine 3' :5-monophosphate-dependent protein kinase regulates myosin light chain kinase. Fed. Proc. 39:1569, 1980.
13. ECKER, A.; RIEMENSCHNEIDER, P.A. - Arteriographic demonstration of spasm of the intracranial arteries: with special reference to saccular arterial aneurysms. J. Neurosurg. 8:660, 1951.
14. EDVINSSON, L.; HARDEBO, J.E.; OWMAN, C.H. - Pharmacological analysis of 5-HT receptors in isolated intracranial and extracranial vessels of rat and man. Cir. Res. 42:143, 1978.
15. FORRESTER, J.H.; YOUNG, D.F. - Flow through a converging-diverging tube and its implication in occlusive vascular disease: 1. Theorectical development. J. Biemech. 3:297, 1970.
16. FRY, D.L. - Certain histological and chemical responses of the vascular interface to acutely induced mechanical stress in the aorta of the dog. Cir. Res. 24:93, 1969.
17. FURCHGOTT, R.F. - Role of endothelium in responses of vascular smooth muscle. Cir. Res. 53:557, 1983.
18. GRADY, P.A.; BLUAMANIS, O.R.; NELSON E.R. - Morphology and flow dynamics of focal arterial constriction. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 107.
19. GREENHOOT, J.H.; REICHENBACH, D.D. - Cardiac injury and subarachnoid hemorrhage, a clinical pathological, physiological correlation. J. Neurosur 30:521, 1969.
20. GROTENHUIS, H.A.; BETTAG, W.; FIEBACH, B.J.O.; DABIR, K. - Intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH. J. Neurosur 61:231, 1984.
21. GRUBB, R.L.; RAICHLE, M.E.; EICHLINS J.O.; GADO, M.H. - Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J. Neurosurg 46:446, 1977.
22. JOHNSON, R.M.; LINCOLN, T.M. - Effects of nitroprusside, glyceryl trinitrate, and 8-bromo cyclic GMP on phosphorylase a formation and myosin light chain phosphorylation in rat aorta. Mol. Pharmacol. 27:333, 1985.
23. KASSELL, N.F.; SASAKI, T.; COLOHAN, A.R.T.; NAZAR, G. - Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16:562, 1985.
24. KASSEL, N.F.; PEERLESS, S.J.; DRAKE, C.G. - Acute proliferative vasculopthy? I. Hypothesis. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 85.
25. KAZDA, S.; TOWART, R. - Nimodipine: a new calcium antagonist drug with a preferential cerebrovascular action. Acta. Neurochir. 63:259, 1982.
26. KONTOS, H.A.; WEI, E.P.; DIETRICH, D.; NAVARY, R.M.; POVLISHOCK, J.T.; GHATAK, N.R.; ELLIS, E.F.: PATTERSON, J.L. Jr. - Mechanism of cerebral arteriolar abnormalities after acute hypertension. Am.. J.. Physiol. 240 (Heart. Circ. Physiol. 9): H511, 1981.
27. KRUEGER, C.; WEIR, B.; NOSKO, M.; COOK, D.; NORRIS, S. - Nimodipine and chronic vasospasm in monkeys: 2 - Pharmacological studies of vessels in spasm. Neurosurgery 16:137, 1985.
28. LASSEN, N.A. - Brain. In P.C. Johnson (ed.): Peripheral Circulation. New York, John Wiley & Sons, 1978, p. 337.
29. LOBATO, R.D.; MANN, J.; SALAICES, M.; RIVILLA, F.; BURGOS, J. - Cerebrovascular reactivity to noradrenaline and serotonin following experimental subarachnoid hemorrhage. J. Neurosurg. 53:480, 1980.
30. McCULLOCH, J.; EVINSSON, L. - Cerebrovascular smooth muscle reactivity - a critical appraisal of in vitro and in situ techniques. JCBFM 4:129, 1984.
31. MILLER, CA. - Biochemistry of vascular smooth muscle: Contractile mechanism of human basilar artery. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 68.
32. MILLER, J.D. - Control of the cerebral circulation. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 76.
33. MOHAMED, A.A.; MENDELOW, A.D.: TEASDALE, G.M.; HARPER, A.M.; Mc CULLOCH, J. - Effect of the calcium antagonist nimodipine on local cerebral blood flow and metabolic coupling. JCBFM 5:26, 1985.
34. MOHAMED, A.A.; McCULLOCH, J.; MENDELOW, A.D.; TEASDALE, G.M.; HARPER, A.M. - Effect of the calcium antagonist nimodipine on local cerebral blood flow: relationship to arterial blood pressure. JCBFM 4:206, 1984.
35. MOROOKA, H. - Cerebral arterip' spasm: I. Adrenergic mechanism in experimental cerebral vasospasm. Acta. Med. Okayama 32:23, 1978.
36. PEACH, M.J.; LOEB, A.L.; SINGER, H.A.; SAYE, J. - Endothelium-derived vascular relaxing factor. Hypertension 7 (suppl. 1): 1, 1985.
37. NAKANO, M.; TANI, E.; FUKUMORI, T.; YOKOTA, M. - Effects of chlorpromazine on experimental delayed cerebral vasospasm. J. Neurosurg. 61:857, 1984.
38. NORWOOD, C.W. - A review of recent advances in vascular smooth muscle pharmacology. In R.H. Wilkins (ed.). Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 57.
39. OLESEN, J.; LAURITZEN, J. - The role of vasoconstriction in the pathogenesis of migraine. In W.D. Amery, J.M.V. Nueten & A. Wauquier (cds.): Pharmacological Basis of Migrain Therapy. London. Pitman Press, 1984, p. 7.
40. PICKARD, J.D.; PERRY, S. - Spectrum of altered reactivity of isolated cerebral arteries following subarachnoid hemorrhage: response to potassium, pH, noradrenaline, 5-hydroxytryptamine, and sodium loading. JCBFM 4:599, 1984.
41. RAY, G.; DAVIDS, N. - Shear stress analysis of blood-endothelial surface in inlet section of artery with plugging. J. Biomechanics 3:99, 1970.
42. SASAKI, T.; ASANO, T.; TAKAKURA, K.; SANO, K.; KASSELL, N.F. - Nature of the vasoactive substance in CSF from patients with subarachnoid hemorrhage. J. Neurosurg. 60:1186, 1984.
43. SHOHAMI, E.; SIDI, A. - Accumulation of prostacyclin in rat brain during hemorrhagic hypotension - Possible role of PG1₂ in autoregulation. JCBFM 4:107, 1984.
44. SMITH, R.R.; CLOWER, B.R.; GROTENDORST, G.M.; YABYNO, N.; CRUSE, J.M. - Arterial wall changes in early human vasospasm. Neurosurgery 16:171, 1985.
45. SPALLONE, A. - Cerebral vaosopasm as a complication of aneurysmal subarachnoid hemorrhage: brief review. Ital. J. Neurol. Sei. 6:19, 1985.
46. TANABE, Y.; SAKATA, K.; YAMADA, H.; ITO, T.; TAKADA, M. - Cerebral vasospasm and ultrastructural changes in cerebral arterial wall an experimental study. J. Neurosurg. 49:229, 1978.
47. TANI, E.; YAMAGATA, S.; MAEDA, Y.; ITO, Y. - Cytochemical demonstration of adenylate and guanylate cyclases in vascular smooth muscle of circle of Willis. J. Neurosur. 49:239, 1978.
48. TODA, N.; SHIMIZY, K.; OHTA, T. - Mechanism of cerebral arterial contraction induced by blood constituents. J. Neurosurg. 53:312, 1980.
49. TSUKAHARA, T.; TANIGYCHI, T.; FUJIWARA, M.; HANDA, J.; NICHIKAMA, M. - Alterations in alpha adrenergic receptors in human cerebral artery after subarachnoid hemorrhage. Stroke 16:53, 1985.
50. VAN BREEMEN, C.; SIEGEL, B.; KALINOSKI, L.; AERA, P.; HWANG, O. - The Ca-f-f cycle of arterial smooth muscle. Cerebral Arterial Spasm. Baltimore, William and Wilkins, 1980, p. 61.
51. VAN NUETEN, J.M. - Antivasoconstrictor effects of drugs used in migrain therapy. In W.D. Amery, J.M.V. Nueten and A. Wauquier (eds): Pharmacological Basis of Migrain Therapy Pitman Press, London, 1984, p. 19.
52. WEI, E.P.; KONTOS, H.A.; CHRISTMAN, C.W.; DeWITT, DS; POVL.ISHOCK, J.T. - Superoxide generation and reversal of acetycholine-induced cerebral arteriolar dilation after acute hypertension. Cir. Res. (In press).
53. WELL.TJM, G.R.; PETERSON, J.W.; ZERVAS, N.T. - The relevance of in vitro smooth muscle experiments of cerebral vasospasm. Stroke 6:573, 1985.
54. YOSHIOKA, J.; CLOWER, B.R.; SMITH, R.R. - The angiopathy of subarachnoid hemorrhage. I. Role of vessel wall catecholamines. Stroke 15:288, 1984.
55. EIJLSTRA, W.G. - Physiology of the cerebral circulation. In J.M. Minderhoud (ed.): Cerebral Blood Flow, Basic Knowledge and Clinical Implications. Exerpta Medica, Amsterdam, 1981.

Datas de Publicação

Publicação nesta coleção
22 Jun 2011
Data do Fascículo
Set 1987

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALEXANDER III, E.; BLACK, P.M.C.L.; LISZCZAK, T.M.; ZERVAS, N.T. - Delayed CSF lavage for artériographie and morphological vasospasm after experimental SAH. J. Neurosurg 63:949, 1985.

[2] 2. ALKSNE, J.F.; GREENHOOT, J.H. - Experimental catecholamine-induced cerebral vasospasm: myonecrosis in vessel wall. J. Neurosur 41:440, 1974.

[3] 3. ALLEN, G.S. - Cerebral arterial spasm: a discussion of present and future research. Neurosurgery 1:142, 1977.

[4] 4. ALLEN, G.S.; AHN, H.S.; PREZIOSI, T.J. et al. - Cerebral arterial spasm - a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N. Engl. J. Med. 308:619, 1983.

[5] 5. BAUMBACH, G.L.; HEISTAD, D.D. - Effect of sympathetic stimulation and changes in arterial pressure on segmental resistance of cerebral vessels in rabbits and cats. Cir. Res. 52:527, 1983.

[6] 6. BEKS, J.W.F. - Cerebral vasospasm and increased intracranial pressure. In R.H. Wilkins (ed.) : Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 412.

[7] 7. BERRIDGE, M.J. - Cellular control through interaction between nucleotides and calcium. Advances in Cyclic Nucleotide and Protein Phosphorylation Res. 17:329, 1984.

[8] 8. BLAUMANIS, O.R.; GRADY, P.A. - Experimental cerebral vasospasm: resolution by chloropromazine. Surg. Neurol. 17:263, 1982.

[9] 9. BURNSTOCK, G. - Nervous control of cerebral blood vessels: a new hypothesis of the mechanism underlying migraine. In F.C. Rose & K.J.Ailkha (eds.): Progress in Migraine Research 1. London, Pitman Press, 1981. p. 17.

[10] 10. BUSIJA D.W. - Role of prostaglandins in modulating synmpathetic vasoconstriction in the cerebral circulation in anesthetized rabbits. JCBFM 17:24, 1985.

[11] 11. CLARK, C. - Turbulent velocity measurements in a model of aortic stenosis. J. Biomech. 9:677, 1976.

[12] 12. CONTI, M.A.; ADELSTEIN, R.S. - Phosphorylation by cyclic adenosine 3' :5-monophosphate-dependent protein kinase regulates myosin light chain kinase. Fed. Proc. 39:1569, 1980.

[13] 13. ECKER, A.; RIEMENSCHNEIDER, P.A. - Arteriographic demonstration of spasm of the intracranial arteries: with special reference to saccular arterial aneurysms. J. Neurosurg. 8:660, 1951.

[14] 14. EDVINSSON, L.; HARDEBO, J.E.; OWMAN, C.H. - Pharmacological analysis of 5-HT receptors in isolated intracranial and extracranial vessels of rat and man. Cir. Res. 42:143, 1978.

[15] 15. FORRESTER, J.H.; YOUNG, D.F. - Flow through a converging-diverging tube and its implication in occlusive vascular disease: 1. Theorectical development. J. Biemech. 3:297, 1970.

[16] 16. FRY, D.L. - Certain histological and chemical responses of the vascular interface to acutely induced mechanical stress in the aorta of the dog. Cir. Res. 24:93, 1969.

[17] 17. FURCHGOTT, R.F. - Role of endothelium in responses of vascular smooth muscle. Cir. Res. 53:557, 1983.

[18] 18. GRADY, P.A.; BLUAMANIS, O.R.; NELSON E.R. - Morphology and flow dynamics of focal arterial constriction. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 107.

[19] 19. GREENHOOT, J.H.; REICHENBACH, D.D. - Cardiac injury and subarachnoid hemorrhage, a clinical pathological, physiological correlation. J. Neurosur 30:521, 1969.

[20] 20. GROTENHUIS, H.A.; BETTAG, W.; FIEBACH, B.J.O.; DABIR, K. - Intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH. J. Neurosur 61:231, 1984.

[21] 21. GRUBB, R.L.; RAICHLE, M.E.; EICHLINS J.O.; GADO, M.H. - Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J. Neurosurg 46:446, 1977.

[22] 22. JOHNSON, R.M.; LINCOLN, T.M. - Effects of nitroprusside, glyceryl trinitrate, and 8-bromo cyclic GMP on phosphorylase a formation and myosin light chain phosphorylation in rat aorta. Mol. Pharmacol. 27:333, 1985.

[23] 23. KASSELL, N.F.; SASAKI, T.; COLOHAN, A.R.T.; NAZAR, G. - Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16:562, 1985.

[24] 24. KASSEL, N.F.; PEERLESS, S.J.; DRAKE, C.G. - Acute proliferative vasculopthy? I. Hypothesis. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 85.

[25] 25. KAZDA, S.; TOWART, R. - Nimodipine: a new calcium antagonist drug with a preferential cerebrovascular action. Acta. Neurochir. 63:259, 1982.

[26] 26. KONTOS, H.A.; WEI, E.P.; DIETRICH, D.; NAVARY, R.M.; POVLISHOCK, J.T.; GHATAK, N.R.; ELLIS, E.F.: PATTERSON, J.L. Jr. - Mechanism of cerebral arteriolar abnormalities after acute hypertension. Am.. J.. Physiol. 240 (Heart. Circ. Physiol. 9): H511, 1981.

[27] 27. KRUEGER, C.; WEIR, B.; NOSKO, M.; COOK, D.; NORRIS, S. - Nimodipine and chronic vasospasm in monkeys: 2 - Pharmacological studies of vessels in spasm. Neurosurgery 16:137, 1985.

[28] 28. LASSEN, N.A. - Brain. In P.C. Johnson (ed.): Peripheral Circulation. New York, John Wiley & Sons, 1978, p. 337.

[29] 29. LOBATO, R.D.; MANN, J.; SALAICES, M.; RIVILLA, F.; BURGOS, J. - Cerebrovascular reactivity to noradrenaline and serotonin following experimental subarachnoid hemorrhage. J. Neurosurg. 53:480, 1980.

[30] 30. McCULLOCH, J.; EVINSSON, L. - Cerebrovascular smooth muscle reactivity - a critical appraisal of in vitro and in situ techniques. JCBFM 4:129, 1984.

[31] 31. MILLER, CA. - Biochemistry of vascular smooth muscle: Contractile mechanism of human basilar artery. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 68.

[32] 32. MILLER, J.D. - Control of the cerebral circulation. In R.H. Wilkins (ed.): Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 76.

[33] 33. MOHAMED, A.A.; MENDELOW, A.D.: TEASDALE, G.M.; HARPER, A.M.; Mc CULLOCH, J. - Effect of the calcium antagonist nimodipine on local cerebral blood flow and metabolic coupling. JCBFM 5:26, 1985.

[34] 34. MOHAMED, A.A.; McCULLOCH, J.; MENDELOW, A.D.; TEASDALE, G.M.; HARPER, A.M. - Effect of the calcium antagonist nimodipine on local cerebral blood flow: relationship to arterial blood pressure. JCBFM 4:206, 1984.

[35] 35. MOROOKA, H. - Cerebral arterip' spasm: I. Adrenergic mechanism in experimental cerebral vasospasm. Acta. Med. Okayama 32:23, 1978.

[36] 36. PEACH, M.J.; LOEB, A.L.; SINGER, H.A.; SAYE, J. - Endothelium-derived vascular relaxing factor. Hypertension 7 (suppl. 1): 1, 1985.

[37] 37. NAKANO, M.; TANI, E.; FUKUMORI, T.; YOKOTA, M. - Effects of chlorpromazine on experimental delayed cerebral vasospasm. J. Neurosurg. 61:857, 1984.

[38] 38. NORWOOD, C.W. - A review of recent advances in vascular smooth muscle pharmacology. In R.H. Wilkins (ed.). Cerebral Arterial Spasm. Baltimore, William & Wilkins, 1980, p. 57.

[39] 39. OLESEN, J.; LAURITZEN, J. - The role of vasoconstriction in the pathogenesis of migraine. In W.D. Amery, J.M.V. Nueten & A. Wauquier (cds.): Pharmacological Basis of Migrain Therapy. London. Pitman Press, 1984, p. 7.

[40] 40. PICKARD, J.D.; PERRY, S. - Spectrum of altered reactivity of isolated cerebral arteries following subarachnoid hemorrhage: response to potassium, pH, noradrenaline, 5-hydroxytryptamine, and sodium loading. JCBFM 4:599, 1984.

[41] 41. RAY, G.; DAVIDS, N. - Shear stress analysis of blood-endothelial surface in inlet section of artery with plugging. J. Biomechanics 3:99, 1970.

[42] 42. SASAKI, T.; ASANO, T.; TAKAKURA, K.; SANO, K.; KASSELL, N.F. - Nature of the vasoactive substance in CSF from patients with subarachnoid hemorrhage. J. Neurosurg. 60:1186, 1984.

[43] 43. SHOHAMI, E.; SIDI, A. - Accumulation of prostacyclin in rat brain during hemorrhagic hypotension - Possible role of PG1₂ in autoregulation. JCBFM 4:107, 1984.

[44] 44. SMITH, R.R.; CLOWER, B.R.; GROTENDORST, G.M.; YABYNO, N.; CRUSE, J.M. - Arterial wall changes in early human vasospasm. Neurosurgery 16:171, 1985.

[45] 45. SPALLONE, A. - Cerebral vaosopasm as a complication of aneurysmal subarachnoid hemorrhage: brief review. Ital. J. Neurol. Sei. 6:19, 1985.

[46] 46. TANABE, Y.; SAKATA, K.; YAMADA, H.; ITO, T.; TAKADA, M. - Cerebral vasospasm and ultrastructural changes in cerebral arterial wall an experimental study. J. Neurosurg. 49:229, 1978.

[47] 47. TANI, E.; YAMAGATA, S.; MAEDA, Y.; ITO, Y. - Cytochemical demonstration of adenylate and guanylate cyclases in vascular smooth muscle of circle of Willis. J. Neurosur. 49:239, 1978.

[48] 48. TODA, N.; SHIMIZY, K.; OHTA, T. - Mechanism of cerebral arterial contraction induced by blood constituents. J. Neurosurg. 53:312, 1980.

[49] 49. TSUKAHARA, T.; TANIGYCHI, T.; FUJIWARA, M.; HANDA, J.; NICHIKAMA, M. - Alterations in alpha adrenergic receptors in human cerebral artery after subarachnoid hemorrhage. Stroke 16:53, 1985.

[50] 50. VAN BREEMEN, C.; SIEGEL, B.; KALINOSKI, L.; AERA, P.; HWANG, O. - The Ca-f-f cycle of arterial smooth muscle. Cerebral Arterial Spasm. Baltimore, William and Wilkins, 1980, p. 61.

[51] 51. VAN NUETEN, J.M. - Antivasoconstrictor effects of drugs used in migrain therapy. In W.D. Amery, J.M.V. Nueten and A. Wauquier (eds): Pharmacological Basis of Migrain Therapy Pitman Press, London, 1984, p. 19.

[52] 52. WEI, E.P.; KONTOS, H.A.; CHRISTMAN, C.W.; DeWITT, DS; POVL.ISHOCK, J.T. - Superoxide generation and reversal of acetycholine-induced cerebral arteriolar dilation after acute hypertension. Cir. Res. (In press).

[53] 53. WELL.TJM, G.R.; PETERSON, J.W.; ZERVAS, N.T. - The relevance of in vitro smooth muscle experiments of cerebral vasospasm. Stroke 6:573, 1985.

[54] 54. YOSHIOKA, J.; CLOWER, B.R.; SMITH, R.R. - The angiopathy of subarachnoid hemorrhage. I. Role of vessel wall catecholamines. Stroke 15:288, 1984.

[55] 55. EIJLSTRA, W.G. - Physiology of the cerebral circulation. In J.M. Minderhoud (ed.): Cerebral Blood Flow, Basic Knowledge and Clinical Implications. Exerpta Medica, Amsterdam, 1981.

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Vasoespasmo cerebral

Cerebral vasospasm

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