ABSTRACT
Based on the previously suggested hypothesis that the generation of free radicals leading to lipid peroxidation is involved in the genesis of vasospasm and vasculopathy following subarachnoid hemorrhage, the therapeutic effect of EGb 761 as an antioxidant on experimental vasospasm and vasculopathy was evaluated in a double hemorrhage dog model of chronic cerebral vasospasm. For this study 14 dogs were randomly assigned to two groups, a control and a Ginkgo biloba group. The control group was only administered saline in a volume equivalent to a dose of 100 mgEGb 761/kg while the treatment group was given 100 mg EGb 761/kg. The diameter of the basilar artery decreased from 1.95 +/- 0.16 mm at day 0 to 1.11 +/- 0.07 mm at day 8 in the control group, while in the treatment group the vessel diameter decreased from 2.01 +/- 0.17 mm at day 0 to 1.72 +/- 0.16 mm at day 8. These results correspond a decrease in vessel diameter of 15.1% in the treatment group and of 43.1% in the control group (P < 0.05). Histopathological studies of the specimens obtained from basilar arteries showed that pathological signs of proliferative vasculopathy, including narrowing of the vessel lumen, corrugation of the lamina elastica and subendothelial thickening, were present in all the animals in the control group, while they could not be demonstrated in the Ginkgo biloba group. These results suggest that Ginkgo biloba may have a protective effect against subarachnoid hemorrhage-induced vasospasm and vasculopathy as a result of antioxidants.
Subject(s)
Flavonoids/pharmacology , Ischemic Attack, Transient/prevention & control , Plant Extracts , Subarachnoid Hemorrhage/physiopathology , Vasodilator Agents/pharmacology , Animals , Basilar Artery/drug effects , Basilar Artery/physiopathology , Cerebral Angiography , Dogs , Ginkgo biloba , Ischemic Attack, Transient/physiopathology , Random Allocation , Statistics, NonparametricABSTRACT
112 cases of primary intracerebral hematomas treated surgically, 25 cases aspirated with urokinase infusion and 25 cases treated conservatively in the last five years were reviewed in detail. In the craniotomy group, 17 out of 44 survivors showed good recovery and returned to normal life, 18 of them went home needing no care, 8 went home needing partial care, and one was bedridden. The overall mortality rate in this group was 59.8%. In the urokinase group, 6 out of 21 survivors showed good recovery and returned to normal life, 11 of them went home needing no care, 3 went home needing partial care and one was bedridden. The overall mortality rate in this group was 16%. In the conservative group, 8 out of 19 survivors showed good recovery and returned to normal life, 9 of them went home needing no care, and two went home needing partial care. The overall mortality rate in this group was 24%. Although the mortality rate was lower in the urokinase group compared with the conservative group, there was no statistically significant difference between the two groups (P > 0.05). These results indicate that surgery is useless in deeply comatose patients and CT-guided aspiration with urokinase is a simple, effective, and safe method in appropriately selected patients.
