Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
复制标题
氯丁醇保存的动脉内罂粟碱用于治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的神经毒性。
DOI：
10.1161/01.str.0000144682.00822.83
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发表时间：
2004
期刊：
影响因子：
8.3
通讯作者：
Halbach,VanV
中科院分区：
文献类型：
--
作者：
Smith,WadeS;Dowd,ChristopherF;Johnston,SClaiborne;Ko,NerissaU;DeArmond,StephenJ;Dillon,WilliamP;Setty,Deepa;Lawton,MichaelT;Young,WilliamL;Higashida,RandallT;Halbach,VanV
背景和目的：罂粟碱用于扩张蛛网膜下腔出血引起的脑血管痉挛。然而，罂粟碱抑制细胞呼吸在体外，并可能导致神经毒性在human. Methods，我们研究了5个连续的脑血管痉挛患者治疗动脉内罂粟碱保存与氯丁醇和成像与MRI液体衰减反转恢复和扩散加权成像治疗后。一名患者进行了组织学分析的大脑在尸检。结果-所有5例患者治疗后立即表现出显着的神经功能下降，这是持续通过出院。在所有病例中，MRI图像显示罂粟碱治疗的血管区域内仅出现选择性灰质信号变化。1例尸检的组织学分析显示，选择性损伤的神经元岛相对稀疏的白色matter. Conclusions-动脉内交付罂粟碱保存与氯丁醇到血管痉挛的大脑前动脉可能会导致显着的神经功能恶化与选择性灰质的变化在MRI成像。该效应与对人脑的永久毒性效应一致。目前还不清楚这种毒性是由罂粟碱还是氯丁醇引起的，它在治疗脑血管痉挛中的使用应该保留给没有替代品的病例。
Background and Purpose—Papaverine is used to vasodilate cerebral arteries undergoing vasospasm from subarachnoid hemorrhage. However, papaverine inhibits cellular respiration in vitro and could cause neurotoxicity in humans.Methods—We studied 5 consecutive patients with cerebral vasospasm who were treated with intra-arterial papaverine preserved with chlorobutanol and imaged with MRI fluid-attenuated inversion recovery and diffusion-weighted imaging after treatment. One patient had histological analysis of the brain at autopsy.Results—All 5 patients exhibited marked neurological decline immediately after treatment, and this was sustained through hospital discharge. In all cases, MRI images showed selective gray matter–only signal changes within the vascular territory treated with papaverine. Histological analysis of 1 case brought to autopsy showed selective injury to islands of neurons with relative sparing of white matter.Conclusions—Intra-arterial delivery of papaverine preserved with chlorobutanol into vasospastic anterior cerebral arteries may result in marked neurological deterioration with selective gray matter changes on MRI imaging. This effect is consistent with a permanent toxic effect to human brain. It is unclear whether this toxicity is caused by papaverine or chlorobutanol, and its use in the treatment of cerebral vasospasm should be reserved for cases without alternatives.