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The 10,000 fold effect of nitric oxide: use of intracarotid sodium nitroprusside
e416
Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
Results: Symptomatic plaques were associated with median GSM of 8 whereas asymptomatic ones with 31 (p = 0.0001). The corresponding values for: 1) median ipsilateral stenosis were: 80% for symptomatic plaques and 70% for asymptomatic ones (p = 0.0001) and 2) median contralateral stenosis were: 55% for index symptomtomatic side and 65% for index asymptomatic side (p = 0.008). Conclusion: Our results indicated that GSM and stenosis of plaques, both in the index side, separated symptomatic and asymptomatic ones. As to the contralateral stenosis, our results indicated tight stenosis predisposes to an asymptomatic status in the index side, suggesting that contralateral severe stenosis stimulates the development of cerebral collateral circulation and thus offering protection.
Conclusions: ICSNP is a swift-acting drug in the treatment of stroke, acting within 90 seconds on 9.5 post-stroke day with a small decrease after 24 hours then to normal in due course.
doi:10.1016/j.jns.2015.08.1464
Cerebral proliferative angiopathy (CPA) is an unusual type of vascular malformation with unique clinical and imaging characteristics that distinguish it from the classic arteriovenous malformations. The features of CPA include absence of dominant arterial feeders or flow-related aneurysms, capillary angioectasia without large draining veins, and presence of intermingled normal brain parenchyma that is hypoperfused. CPA represents 3.4% of all AVMs, a few cases have been described in the world literature till now, after the original series of Lasjaunias et al. (2008) and the natural history presentation include seizures, headaches, and a lower risk for cerebral hemorrhage. We described a 41 year-old woman presented recently aggravating headache with severe thunderclap exacerbation. Cerebral MRI, computed tomography angiogram and catheter angiography revealed a single right temporal hemmorrhage without aneuryms and a minimal diffuse vascular network involving cortical vessels. A right hemispheric proliferative vascular malformation, without evidence of dural arteriovenous fistula, was diagnosed. This interesting presentation reveals a unique look for a initial CPA.
1434 WFN15-0055 Stroke The 10,000 fold effect of nitric oxide: use of intracarotid sodium nitroprusside V. Tewaria, M. Hussainb, H.K. Das Guptac. aNeurosurgery, Neuro Center, Lucknow, India; bNeurosurgery, Sahara Hospital, Lucknow, India; c Surgery, Jhalawar Hospital, Jhalawar Rajasthan, India
Background: rTPA showed level-1 benefit in AIS. Intracarotidsodium-nitroprusside(ICSNP)studied here for wide-treatment-window and fast-recovery. a) RETROGRADE-NEUROTRANSMISSION-RNT(acute): 1) Normal-impulse: At synaptic-level, glutamate-activates NMDAreceptors, having nitric-oxide-synthetase(NOS)on postsynapticneuron, for further propagation by calcium-calmodulin-complex. Nitric-oxide(NO-produced-by-NOS)travels-backward across chemical-synapse(CS), binds NO-receptor/sGC of presynaptic-neuron, regulating anterograde-neurotransmission(ANT). Heme(ligandbinding-site)exhibits N10,000-fold higher affinity for NO than for oxygen(10,000-fold-effect). 2) Stroke: Normal synaptic-activity, ANT and RNT are absent. NOdonor(SNP)releases NO from NOS. NO travels backward across CS to bind heme of NO-receptor/sGC, generates ELECTRICAL-IMPULSE, as in normal-ANT. b) VASOSPASM(acute): Juxtra-penumbra-perforators show vasospastic activity. NO vasodilates the perforators via the NO-cAMP-pathway. c) LONG-TERM POTENTIATION(LTP)chronic: Via NO–cGMP-pathway.
Aims/study design: to treat acute-stroke by RNT/vasodilatation, and chronic-stroke by LTP. Case-control-prospective-study. Materials and methods: 200-patients (100-control and 100 patients ICSNP group). Mean time for superfusion was 9.5 days post-stroke. Status was monitored by NIHSS, MRI and TCD. Results: After 90-seconds in ICSNP group, mean change in NIHSS score was decrease of 1.44-points/6.55%; after 2-h, decrease of 1.16-points; after 24-h, increase of 0.66-points/2.25%, compared to control-group increase of 0.7 points, or 3.53%; at 7 days, 8.61-point decrease, 44.58%, compared to the control-group increase of 2.55 points, or 22.37%; at 2 months 6.94-points decrease, 62.80%, compared to the control-group decrease of 2.77 points, or 8.78%.
doi:10.1016/j.jns.2015.08.1465 1436 WFN15-1269 Stroke Early hemmorhage in initial cerebral proliferative angiopathy A. Torche, P. Sandoval, A. Marquez, P. Mellado Departamento de Neurología, Hospital Clínico Pontifícia Universidad Católica, Santiago, Chile
Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
Results: Symptomatic plaques were associated with median GSM of 8 whereas asymptomatic ones with 31 (p = 0.0001). The corresponding values for: 1) median ipsilateral stenosis were: 80% for symptomatic plaques and 70% for asymptomatic ones (p = 0.0001) and 2) median contralateral stenosis were: 55% for index symptomtomatic side and 65% for index asymptomatic side (p = 0.008). Conclusion: Our results indicated that GSM and stenosis of plaques, both in the index side, separated symptomatic and asymptomatic ones. As to the contralateral stenosis, our results indicated tight stenosis predisposes to an asymptomatic status in the index side, suggesting that contralateral severe stenosis stimulates the development of cerebral collateral circulation and thus offering protection.
Conclusions: ICSNP is a swift-acting drug in the treatment of stroke, acting within 90 seconds on 9.5 post-stroke day with a small decrease after 24 hours then to normal in due course.
doi:10.1016/j.jns.2015.08.1464
Cerebral proliferative angiopathy (CPA) is an unusual type of vascular malformation with unique clinical and imaging characteristics that distinguish it from the classic arteriovenous malformations. The features of CPA include absence of dominant arterial feeders or flow-related aneurysms, capillary angioectasia without large draining veins, and presence of intermingled normal brain parenchyma that is hypoperfused. CPA represents 3.4% of all AVMs, a few cases have been described in the world literature till now, after the original series of Lasjaunias et al. (2008) and the natural history presentation include seizures, headaches, and a lower risk for cerebral hemorrhage. We described a 41 year-old woman presented recently aggravating headache with severe thunderclap exacerbation. Cerebral MRI, computed tomography angiogram and catheter angiography revealed a single right temporal hemmorrhage without aneuryms and a minimal diffuse vascular network involving cortical vessels. A right hemispheric proliferative vascular malformation, without evidence of dural arteriovenous fistula, was diagnosed. This interesting presentation reveals a unique look for a initial CPA.
1434 WFN15-0055 Stroke The 10,000 fold effect of nitric oxide: use of intracarotid sodium nitroprusside V. Tewaria, M. Hussainb, H.K. Das Guptac. aNeurosurgery, Neuro Center, Lucknow, India; bNeurosurgery, Sahara Hospital, Lucknow, India; c Surgery, Jhalawar Hospital, Jhalawar Rajasthan, India
Background: rTPA showed level-1 benefit in AIS. Intracarotidsodium-nitroprusside(ICSNP)studied here for wide-treatment-window and fast-recovery. a) RETROGRADE-NEUROTRANSMISSION-RNT(acute): 1) Normal-impulse: At synaptic-level, glutamate-activates NMDAreceptors, having nitric-oxide-synthetase(NOS)on postsynapticneuron, for further propagation by calcium-calmodulin-complex. Nitric-oxide(NO-produced-by-NOS)travels-backward across chemical-synapse(CS), binds NO-receptor/sGC of presynaptic-neuron, regulating anterograde-neurotransmission(ANT). Heme(ligandbinding-site)exhibits N10,000-fold higher affinity for NO than for oxygen(10,000-fold-effect). 2) Stroke: Normal synaptic-activity, ANT and RNT are absent. NOdonor(SNP)releases NO from NOS. NO travels backward across CS to bind heme of NO-receptor/sGC, generates ELECTRICAL-IMPULSE, as in normal-ANT. b) VASOSPASM(acute): Juxtra-penumbra-perforators show vasospastic activity. NO vasodilates the perforators via the NO-cAMP-pathway. c) LONG-TERM POTENTIATION(LTP)chronic: Via NO–cGMP-pathway.
Aims/study design: to treat acute-stroke by RNT/vasodilatation, and chronic-stroke by LTP. Case-control-prospective-study. Materials and methods: 200-patients (100-control and 100 patients ICSNP group). Mean time for superfusion was 9.5 days post-stroke. Status was monitored by NIHSS, MRI and TCD. Results: After 90-seconds in ICSNP group, mean change in NIHSS score was decrease of 1.44-points/6.55%; after 2-h, decrease of 1.16-points; after 24-h, increase of 0.66-points/2.25%, compared to control-group increase of 0.7 points, or 3.53%; at 7 days, 8.61-point decrease, 44.58%, compared to the control-group increase of 2.55 points, or 22.37%; at 2 months 6.94-points decrease, 62.80%, compared to the control-group decrease of 2.77 points, or 8.78%.
doi:10.1016/j.jns.2015.08.1465 1436 WFN15-1269 Stroke Early hemmorhage in initial cerebral proliferative angiopathy A. Torche, P. Sandoval, A. Marquez, P. Mellado Departamento de Neurología, Hospital Clínico Pontifícia Universidad Católica, Santiago, Chile