Indomethacin for Prevention of Neonatal Intraventricular Hemorrhage

Up to 50 percent of premature infants develop an intracerebral hemorrhage. Intracerebral hemorrhage in neonates occurs most frequently in the periventricular or intraventricular areas. Intravascular, vascular, and extravascular factors influence the development of hemorrhage. Pharmacologic therapies, such as phenobarbital, vitamin K, pancuronium bromide, vitamin E, and indomethacin, have been used in an attempt to prevent intraventricular hemorrhage (IH). Indomethacin inhibits prostaglandin production, which results in cerebral vasoconstriction and reduced cerebral blood flow. Several clinical studies have evaluated the role of indomethacin for the prevention of IH in premature infants. No definitive recommendations can be made regarding indomethacin use for this purpose. However, the two largest studies conducted to date have shown indomethacin to be effective in preventing or limiting the progression of IH. The drug appears to be most effective in reducing low-grade IH. More extensive research is needed to determine the most effective dose, duration, and serum concentration of indomethacin.

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Hemoglobin, NO, and 20-HETE interactions in mediating cerebral vasoconstriction following SAH

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00445.2005 ◽

2006 ◽

Vol 290 (1) ◽

pp. R84-R89 ◽

Cited By ~ 14

Author(s):

Kazuhiko Takeuchi ◽

Noriyuki Miyata ◽

Marija Renic ◽

David R. Harder ◽

Richard J. Roman

Keyword(s):

Nitric Oxide ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Subarachnoid Hemorrhage ◽

Methyl Ester ◽

Cerebral Vasoconstriction ◽

Vasoactive Factors ◽

Vasoconstrictor Response

Recent studies have indicated that 20-hydroxyeicosatetraenoic acid (20-HETE) contributes to the fall in cerebral blood flow (CBF) after subarachnoid hemorrhage (SAH), but the factors that stimulate the production of 20-HETE are unknown. This study examines the role of vasoactive factors released by clotting blood vs. the scavenging of nitric oxide (NO) by hemoglobin (Hb) in the fall in CBF after SAH. Intracisternal (icv) injection of blood produced a greater and more prolonged (120 vs. 30 min) decrease in CBF than that produced by a 4% solution of Hb. Pretreating rats with Nω-nitro-l-arginine methyl ester (l-NAME; 10 mg/kg iv) to block the synthesis of NO had no effect on the fall in CBF produced by an icv injection of blood. l-NAME enhanced rather than attenuated the fall in CBF produced by an icv injection of Hb. Blockade of the synthesis of 20-HETE with TS-011 (0.1 mg/kg iv) prevented the sustained fall in CBF produced by an icv injection of blood and the transient vasoconstrictor response to Hb. Hb (0.1%) reduced the diameter of the basilar artery (BA) of rats in vitro by 10 ± 2%. This response was reversed by TS-011 (100 nM). Pretreatment of vessels with l-NAME (300 μM) reduced the diameter of BA and blocked the subsequent vasoconstrictor response to the addition of Hb to the bath. TS-011 returned the diameter of vessels exposed to l-NAME and Hb to that of control. These results suggest that the fall in CBF after SAH is largely due to the release of vasoactive factors by clotting blood rather than the scavenging of NO by Hb and that 20-HETE contributes the vasoconstrictor response of cerebral vessels to both Hb and blood.

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The Role of Sartans in the Treatment of Stroke and Subarachnoid Hemorrhage: A Narrative Review of Preclinical and Clinical Studies

Brain Sciences ◽

10.3390/brainsci10030153 ◽

2020 ◽

Vol 10 (3) ◽

pp. 153 ◽

Cited By ~ 2

Author(s):

Stefan Wanderer ◽

Basil E. Grüter ◽

Fabio Strange ◽

Sivani Sivanrupan ◽

Stefano Di Santo ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasoconstriction ◽

Delayed Cerebral Vasospasm ◽

Endothelin System ◽

Pubmed Database ◽

Cerebral Inflammation

Background: Delayed cerebral vasospasm (DCVS) due to aneurysmal subarachnoid hemorrhage (aSAH) and its sequela, delayed cerebral ischemia (DCI), are associated with poor functional outcome. Endothelin-1 (ET-1) is known to play a major role in mediating cerebral vasoconstriction. Angiotensin-II-type-1-receptor antagonists such as Sartans may have a beneficial effect after aSAH by reducing DCVS due to crosstalk with the endothelin system. In this review, we discuss the role of Sartans in the treatment of stroke and their potential impact in aSAH. Methods: We conducted a literature research of the MEDLINE PubMed database in accordance with PRISMA criteria on articles published between 1980 to 2019 reviewing: “Sartans AND ischemic stroke”. Of 227 studies, 64 preclinical and 19 clinical trials fulfilled the eligibility criteria. Results: There was a positive effect of Sartans on ischemic stroke in both preclinical and clinical settings (attenuating ischemic brain damage, reducing cerebral inflammation and infarct size, increasing cerebral blood flow). In addition, Sartans reduced DCVS after aSAH in animal models by diminishing the effect of ET-1 mediated vasoconstriction (including cerebral inflammation and cerebral epileptogenic activity reduction, cerebral blood flow autoregulation restoration as well as pressure-dependent cerebral vasoconstriction). Conclusion: Thus, Sartans might play a key role in the treatment of patients with aSAH.

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Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage

Scientific Reports ◽

10.1038/srep25903 ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 19

Author(s):

Pei-Yi Lin ◽

Katherine Hagan ◽

Angela Fenoglio ◽

P. Ellen Grant ◽

Maria Angela Franceschini

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Intraventricular Hemorrhage ◽

Oxygen Metabolism ◽

Preterm Neonates ◽

Low Grade ◽

Germinal Matrix ◽

Extremely Preterm

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Cerebral Blood Flow in Premature Infants: Regulation, Measurement, and Pathophysiology of Intraventricular Hemorrhage

Fetal and Neonatal Physiology ◽

10.1016/b978-0-7216-9654-6.50173-9 ◽

2004 ◽

pp. 1745-1756

Author(s):

Jeffrey M. Perlman

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Premature Infants ◽

Intraventricular Hemorrhage

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The role of adenosine in the regulation of cerebral blood flow: antagonistic effects of theophylline, an adenosine receptor blocker, on adenosine- and hypoxia-induced vasodilation of rat cerebral microvessels

The Japanese Journal of Pharmacology ◽

10.1016/s0021-5198(19)58912-0 ◽

1986 ◽

Vol 40 ◽

pp. 31

Author(s):

Seiji Morii ◽

Al C. Ngai ◽

H. Richard Winn

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Adenosine Receptor ◽

Receptor Blocker ◽

Cerebral Microvessels ◽

Antagonistic Effects

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Sound Richness of Music Might Be Mediated by Color Perception: A PET Study

Behavioural Neurology ◽

10.1155/2015/241804 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Masayuki Satoh ◽

Ken Nagata ◽

Hidekazu Tomimoto

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Multisensory Integration ◽

Regional Cerebral Blood Flow ◽

Traditional Music ◽

Simple Condition ◽

Regional Cerebral Blood ◽

Subtraction Technique ◽

Posterior Portion

Objects. We investigated the role of the fusiform cortex in music processing with the use of PET, focusing on the perception of sound richness.Method. Musically naïve subjects listened to familiar melodies with three kinds of accompaniments: (i) an accompaniment composed of only three basic chords (chord condition), (ii) a simple accompaniment typically used in traditional music text books in elementary school (simple condition), and (iii) an accompaniment with rich and flowery sounds composed by a professional composer (complex condition). Using a PET subtraction technique, we studied changes in regional cerebral blood flow (rCBF) in simple minus chord, complex minus simple, and complex minus chord conditions.Results. The simple minus chord, complex minus simple, and complex minus chord conditions regularly showed increases in rCBF at the posterior portion of the inferior temporal gyrus, including the LOC and fusiform gyrus.Conclusions. We may conclude that certain association cortices such as the LOC and the fusiform cortex may represent centers of multisensory integration, with foreground and background segregation occurring at the LOC level and the recognition of richness and floweriness of stimuli occurring in the fusiform cortex, both in terms of vision and audition.

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The Role of Electrode Size on the Incidence of Spreading Depression and on Cortical Cerebral Blood Flow as Measured by H2 Clearance

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.1992.33 ◽

1992 ◽

Vol 12 (2) ◽

pp. 230-237 ◽

Cited By ~ 37

Author(s):

Marleen J. Verhaegen ◽

Michael M. Todd ◽

David S. Warner ◽

Bruce James ◽

Julie B. Weeks

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Gray Matter ◽

Spreading Depression ◽

Insertion Depth ◽

Flow Measurements ◽

Electrode Size ◽

Cortical Gray Matter ◽

The Right

Cerebral blood flow was measured by the H2 clearance method 30 and 60 min after the implantation of 300, 250, 125, or 50 μm diameter platinum–iridium electrodes 2 mm deep into the right parietal cortex of normothermic, normocarbic halothane-anesthetized rats. Another group of animals had 50 μm electrodes inserted 1 mm. In all animals, the presence or absence of a wave of spreading depression (SD) was noted at the time of implantation, with recordings made with glass micropipettes. H2 flow values were compared with those measured in gray matter from the same anatomical region (but from different rats), using [3H]nicotine. The incidence of SD ranged from 60% following insertion of 300 μm electrodes to 0% with 50 μm electrodes. H2 clearance flows also varied with electrode size, from 77 ± 21 ml 100 g−1 min−1 (mean ± standard deviation) with 300 μm electrodes to 110 ± 31 and 111 ± 16 ml 100 g−1 min−1 with 125 and 50 μm electrodes, respectively (insertion depth of 2 mm). A CBF value of 155 ± 60 ml 100 g−1 min−1 was obtained with 50 μm electrodes inserted only 1 mm. Cortical gray matter blood flow measured with [3H]nicotine was 154 ± 35 ml 100 g−1 min−1. When the role of SD in subsequent flow measurements was examined, there was a gradual increase in CBF between 30 and 60 min after electrode insertion in those animals with SD, while no such change was seen in rats without SD. These results indicate that the choice of electrode size and implantation depth influences the measurement of CBF by H2 clearance. CBF values equivalent to those obtained with isotopic techniques can be acutely obtained with small (50 μm diameter) electrodes inserted 1 mm into the cortex. While the occurrence of SD does influence CBF in the period immediately after implantation, a relationship between electrode size and measured flow is present that is independent of SD.

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