Vitamin D as a modifiable risk factor, predictor, and theoretical therapeutic agent for vasospasm in spontaneous subarachnoid hemorrhage.

Delayed deterioration associated with cerebral vasospasm (CVS) is a feared complication after spontaneous subarachnoid hemorrhage (SAH) and is one of the leading causes of death in patients with intracranial hemorrhage. The pathophysiology of vasospasm is complex and not fully understood, involving multiple inflammatory pathways in addition to vasoconstriction induced ischemia. Current treatment with anti-inflammatory or vasodilatory medications has been met with limited success and has not led to a decrease in vasospastic associated mortality prompting continued investigation of potential treatment options. The active form of vitamin D, 1,25-dihydroxyvitamin D3 (1,25-VitD3), is a hormone with downstream effects that induce anti-inflammatory pathways, promote nitric oxide (NO) induced vasodilation, and lead to neuroprotective-gene expression, which may be useful in mitigating the vascular pathogenesis associated with CVS. A high prevalence of vitamin D deficiency has been identified in patients admitted with SAH. Low vitamin D levels in patients, as determined by time of year, has also been correlated to an increased incidence and severity of CVS. Further, the therapeutic usefulness of 1,25-VitD3 has been demonstrated in animal models leading to a decreased incidence of CVS but has yet to be thoroughly investigated in human studies. In this review, we will discuss the findings that suggest the potential of utilizing vitamin D as a predictive indicator, method of prevention, and or treatment option for CVS in patients following spontaneous SAH.

Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women.

Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term "pregnancy-related sacroiliac joint pain." All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.

Neuroprotective strategies of cerebrolysin for the treatment of infants with neonatal hypoxic-ischemic encephalopathy.

BACKGROUND: Perinatal asphyxia (PA) is a devastating neonatal condition characterized by a lack of oxygen supporting the organ systems. PA can lead to hypoxic-ischemic encephalopathy (HIE), a brain dysfunction due to oxygen deprivation with a complex neurological sequela. The pathophysiology of HIE and PA is not entirely understood, with therapeutic hypothermia being the standard treatment with only limited value. However, alternative neuroprotective therapies can be a potential treatment modality. METHODS: In this review, we will characterize the biochemical mechanisms of PA and HIE, while also giving insight into cerebrolysin, a neuroprotective treatment used for HIE and PA. RESULTS: We found that cerebrolysin has up to 6-month treatment window post-ischemic insult. Cerebrolysin injections of 0.1 ml/kg of body weight twice per week were found to provide gross motor and speech deficit improvement. CONCLUSION: Our literature search emphasizes the positive effects of cerebrolysin for general improvement outcomes. Nevertheless, biomarker establishment is warranted to improve patient outcomes.