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Prentice D, Dharsono F, Martinet P. Pathological Laughter: The First Manifestation of Intracerebral Haemorrhage Linked to Phenylephrine Overuse. Cureus 2024; 16:e63461. [PMID: 39077269 PMCID: PMC11285287 DOI: 10.7759/cureus.63461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 07/31/2024] Open
Abstract
A 42-year-old woman presented to the emergency department with sudden-onset uncontrollable laughter, 'fou rire prodromique' (prodrome of crazy laughter), and left leg weakness. Imaging revealed a right cerebral haemorrhage of the premotor cortex corresponding to the leg cortical representation. A history of excess phenylephrine use for sinusitis and migraine was subsequently obtained. The patient's neurological recovery was good, enabling a return to her pre-stroke employment. The neurological causes of pathological laughter and the brain networks involved are discussed in this report. The role of sympathomimetics in the causation of cerebral haemorrhage potentially via the initiation of a reversible cerebral vasoconstriction syndrome is highlighted. The use of over-the-counter substances should be part of medication history in such cases.
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Affiliation(s)
- David Prentice
- Neurosciences, Perron Institute for Neurological and Translational Science, Nedlands, AUS
| | - Ferry Dharsono
- Neuroradiology, Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, AUS
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2
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Galasso M, Cavallotti C, Giannattasio C, Pedrotti P. Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries. J Cardiovasc Med (Hagerstown) 2024; 25:391-393. [PMID: 38555584 DOI: 10.2459/jcm.0000000000001604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Nasal vasoconstrictors are some of the most widely used over-the-counter drugs, considered by many consumers as relatively safe with few significant adverse effects. At recommended dosage, the drug produces local vasoconstriction in nasal mucous membranes. However, the use of such drugs has been linked to cardiovascular adverse effects, including hypertension, arrhythmias, prolongation of the QT interval, and angina pectoris.
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The various cardiovascular adverse effects may occur with both oral and nasal administration and after a single dose or prolonged treatment, without dose-effect and independently of vascular status and age.
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Although the effects of ephedrine and pseudoephedrine have been widely studied, the effects of naphazoline are less well known. We describe the case of a previously healthy man who experienced a MINOCA (myocardial infarction with nonobstructive coronary arteries) after abuse of recommended dose of naphazoline. To our knowledge, this is the first time that a strict temporal relation between the occurrence of MINOCA and topical naphazoline abuse is being described.
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Affiliation(s)
- Michele Galasso
- School of Medicine and Surgery, University of Milano-Bicocca
| | | | - Cristina Giannattasio
- School of Medicine and Surgery, University of Milano-Bicocca
- Cardiologia I
- Cardiologia IV, De Gasperis, Cardio Center, Niguarda Hospital, Milan, Italy
| | - Patrizia Pedrotti
- Cardiologia IV, De Gasperis, Cardio Center, Niguarda Hospital, Milan, Italy
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3
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Puac-Polanco P, Rovira À, Shah LM, Wiggins RH, Rivas Rodriguez F, Torres C. Imaging of Drug-Related Vasculopathy. Neuroimaging Clin N Am 2024; 34:113-128. [PMID: 37951697 DOI: 10.1016/j.nic.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Illicit and recreational drugs, such as cocaine, heroin, amphetamines, and marijuana, can result in drug-related vasculitis or vasculopathy. Similarly, the use of certain antithyroid, oncologic, and immunosuppressive medications for therapeutic purposes can lead to vasculopathy. This in turn may result in significant complications in the central nervous system, including intracranial hemorrhage and stroke. Cocaine abuse can also lead to midline destructive lesions of the sinonasal complex. MR imaging, Vessel Wall imaging, and CT/CTA are valuable imaging tools for the evaluation of patients with suspected drug-induced vasculopathy or vasculitis. This article reviews the pathomechanism, clinical presentation, and imaging findings of vasculopathy related to drug abuse and prescribed medications.
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Affiliation(s)
- Paulo Puac-Polanco
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Hospital Vall d'Hebron Passeig Vall d'Hebron 119-129 08035 Barcelona, Spain
| | - Lubdha M Shah
- Division of Neuroradiology, University of Utah, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Richard H Wiggins
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, University of Utah Health Sciences Center, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Francisco Rivas Rodriguez
- Radiology, Division of Neuroradiology, University of Michigan, 1500 East Medical Center Drive, B2A205 Ann Arbor, MI 48109-5302, USA
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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Banaś BP, Brzeźniakiewicz-Janus K, Majdanik S, Parafiniuk M, Łużny S, Stachowicz A, Janus T. Hemorrhagic stroke caused by xylometazoline poisoning. J Forensic Sci 2024; 69:359-364. [PMID: 37919943 DOI: 10.1111/1556-4029.15416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
An increase in the use of over-the-counter medications has been observed in recent years. This also concerns xylometazoline, approved for the treatment of allergic rhinitis or upper respiratory tract infections. We present the fatal case of a 40 year-old-woman with a massive hemorrhagic stroke. Initial toxicology tests of biological material collected during autopsy revealed the presence of xylometazoline. No other significant toxicology findings were noted. LC-MS/MS method has been developed to determine xylometazoline concentration, which was 18.6 ng/mL in blood and 498.9 ng/mL in urine. The macroscopically detected hemorrhagic focus was confirmed by histopathological which confirmed hemorrhagic infarcts in the brain tissue, especially in the subarachnoid area. No other pathological changes were found. Based on findings from autopsy and toxicological analyses, the direct cause of death was concluded to be hemorrhagic stroke resulting from xylometazoline intoxication. Although xylometazoline products are regarded as relatively safe and are available over the counter, the risk of adverse effects, in particular stroke leading to death, should be considered. If adverse effects are observed, it is reasonable to measure the concentration of the drug in blood and urine. With such data, it will be possible to assess the actual exposure to this xenobiotic and draw firmer conclusions.
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Affiliation(s)
- Barbara Potocka Banaś
- Department of Clinical and Forensic Toxicology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Sławomir Majdanik
- Department of Forensic Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Mirosław Parafiniuk
- Department of Forensic Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Sylwester Łużny
- Department of Clinical and Forensic Toxicology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Agnieszka Stachowicz
- Department of Clinical and Forensic Toxicology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Tomasz Janus
- Department of Clinical and Forensic Toxicology, Pomeranian Medical University in Szczecin, Szczecin, Poland
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RCVS: by clinicians for clinicians-a narrative review. J Neurol 2023; 270:673-688. [PMID: 36305970 PMCID: PMC9615630 DOI: 10.1007/s00415-022-11425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVE Reversible cerebral vasoconstriction syndrome may be underdiagnosed. It can be accompanied by various complications, mainly intracerebral hemorrhage and ischemic stroke. The clinical presentation of this condition varies according to its localization. The aims of this review are to raise awareness of the disease, especially in the presence of corresponding risk factors; to connect its precipitating factors, pathophysiology, and complications; and to compare various differential diagnoses of vasoconstriction. METHODS A review of the literature in PubMed/MEDLINE and Google Scholar was conducted from May 1997 until May 2022. RESULTS Reversible cerebral vasoconstriction syndrome, which is a clinical-radiological syndrome, is mainly characterized by the occurrence of thunderclap headache and widespread vasoconstriction. The most common precipitating factors are the use of vasoactive substances and postpartum status. The pathophysiology is currently assumed to include two mechanisms: sympathetic overactivity and endothelial dysfunction. From these mechanisms, it is possible to derive potential complications as well as the most important differential diagnoses: posterior reversible encephalopathy syndrome, convexity subarachnoid hemorrhage, ischemic and hemorrhagic stroke, and primary angiitis of the central nervous system. CONCLUSION In general, the outcome of reversible cerebral vasoconstriction syndrome is very good. Vasospasm as well as thunderclap headache attacks can be fully reversible, and > 90% of patients are functionally independent at discharge.
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Idris IM, Burnett AL, DeBaun MR. Epidemiology and treatment of priapism in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:450-458. [PMID: 36485155 PMCID: PMC9820196 DOI: 10.1182/hematology.2022000380] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Ischemic priapism is a common but underrecognized morbidity affecting about 33% of adult men with sickle cell disease (SCD). The onset of priapism occurs in the prepubertal period and tends to be recurrent with increasing age. Significantly, priapism is associated with an unrecognized high burden of mental duress and sexual dysfunctions. The diagnosis of priapism is clinical. Many episodes of priapism will resolve spontaneously, but when an episode lasts longer than 4 hours, the episode is considered a urologic emergency requiring quick intervention with either corporal aspiration or shunt surgery. Only 3 randomized clinical trials (stilbesterol, ephedrine or etilefrine, and sildenafil) have been conducted for secondary priapism prevention in SCD. All 3 trials were limited with small sample sizes, selection biases, and inconclusive results after completion. The current molecular understanding of the pathobiology of priapism suggests a relative nitric oxide (NO) deficiency secondary to chronic hemolysis in SCD and associated phosphodiesterase type 5 dysregulation. We posit an increase in NO levels will restore the normal homeostatic relationship between voluntary erection and detumescence. Currently, 2 randomized phase 2 trials (1 double-blind, placebo-controlled trial and 1 open-label, single-arm intervention) are being conducted for secondary priapism prevention in men at high risk for recurrent priapism (NCT03938454 and NCT05142254). We review the epidemiology and pathobiology of priapism, along with mechanistic therapeutic approaches for secondary prevention of priapism in SCD.
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Affiliation(s)
- Ibrahim M. Idris
- Department of Haematology, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
| | | | - Michael R. DeBaun
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University Medical Center, Nashville, TN
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GÜLCÜ ÜSTÜN NS, KARAYAĞMURLU A. Dikkat eksikliği hiperaktivite bozukluğu olan bir ergende modifiye salımlı metilfenidat kaynaklı Raynaud fenomeni. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1121992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commencing before the age of 12 years and characterized by developmentally inappropriate inattention, hyperactivity, and/or impulsivity symptoms. Stimulants such as methylphenidate (MPH) are used as first-line therapy for children with ADHD. Psychostimulants may be associated with vascular problems. Raynaud’s phenomenon (RP) is a peripheral vasculopathy potentially associated with connective tissue diseases characterized by recurring reversible vasospasm attacks triggered by cold and emotional stress. Several cases have been published involving RP observed with MPH. The present report discusses a 14-year-old girl with ADHD who experienced RP with the addition of 10 mg modified-release MPH during 27 mg osmotic release (OROS)-MPH therapy, but not during 36 mg OROS-MPH therapy.
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Affiliation(s)
| | - Ali KARAYAĞMURLU
- ISTANBUL UNIVERSITY, İSTANBUL FACULTY OF MEDICINE, İSTANBUL MEDICINE PR
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Posterior Reversible Encephalopathy Syndrome Occurred During the Use of Pseudoephedrine: A Case Report. Clin Neuropharmacol 2022; 45:145-147. [PMID: 36066857 DOI: 10.1097/wnf.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a syndrome that is manifested by a variety of clinical findings, like headache, seizure, loss of vision and change in consciousness, and characterized by bilateral vasogenic edema, which is usually located in the posterior part of the hemispheres, but sometimes located in atypical localization. CASE PRESENTATION A 56-year-old man with no known systemic disease with generalized tonic clonic seizure was evaluated. He had oral paracetamol + pseudoephedrine HCl for runny nose, sore throat, and headache. After the second dosage, he had a seizure during sleeping. In flair sequence of magnetic resonance imaging, bilateral cortical and subcortical hyperintensities were observed in the posterior parts of the hemispheres and the cerebellar hemispheres, which demonstrated PRES. CONCLUSION We presented a PRES case with seizures after using 2 doses of pseudoephedrine. In addition to hypertension, several factors have been blamed, such as eclampsia-preeclampsia, some immunosuppressive and chemotherapeutic drugs, some kidney diseases. Although the patient had no known risk factors for PRES, he was diagnosed with hypertension and diabetes mellitus during follow-up.
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Bhardwaj A, Mukherjee S, Roy V. Xylometazoline Induced Isolated Left Medial Cerebellar Peduncle Infarct: A Rare Case Report. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221080224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Xylometazoline, a sympathomimetic available as over the counter drug, acts as a nasal decongestant and has been reported as an independent risk factor for hemorrhagic and ischemic stroke. The chronic use of xylometazoline leads to either increased release of more potent vasoconstrictor norepinephrine in the presynaptic region, or acts directly on central adrenoreceptors which leads to dysfunction resulting in chronic progressive vasculopathy that manifests as an ischemic stroke. Sympathomimetics also activate 12-lipoxygenase pathways which induce proliferation and migration of vascular smooth muscle cells. 12-lipoxgenase also plays a significant role in regulating the degree and stability of platelet activation, as its activation significantly strengthens platelet activation and uncontrolled platelet activation, which may lead to myocardial infraction and stroke. The present case reports a rare case of young adult suffering from isolated left medial cerebellar peduncle infarct related to the chronic use of xylometazoline. Acute cerebellar stroke is rare, especially in young adults and represent only 3% of total ischemic and hemorrhagic strokes. Clinical symptoms, patient age at the onset of stroke, and lesion size had no significant effect on the clinical outcome. Symptoms are frequently underestimated and misdiagnosed which further lead to serious complications and poor functional outcomes.
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Affiliation(s)
- Ankit Bhardwaj
- Department of Pharmacology, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - Shoma Mukherjee
- Department of Pharmacology, School of Medical Sciences & Research (SMS&R), Sharda University, Greater Noida, Uttar Pradesh, India
| | - Vandana Roy
- Department of Pharmacology, Maulana Azad Medical College (MAMC) and Lok Nayak Jai Prakash Narayan (LNJP) Hospital, New Delhi, India
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10
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Brust JC. Stroke and Substance Abuse. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Magyar CTJ, Prevost GA, Nett PC. Vasoconstrictor nasal spray causing life-threatening complications after bariatric surgery: A case report. Int J Surg Case Rep 2021; 89:106574. [PMID: 34864257 PMCID: PMC8645905 DOI: 10.1016/j.ijscr.2021.106574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance Bariatric surgery is an evolving surgical field with increasing cases per year, as obesity is prevalent, especially in developed countries. Complication diagnosis and management can be challenging. Marginal ulcers and anastomosis perforation are rare, but their incidence is likely underestimated. Case presentation To the best of our knowledge, we present the first case with a two and a half years history of recurrent ischemia, marginal ulcers, and recurrent perforation after laparoscopic omega loop gastric bypass, most likely due to an abuse of an over-the-counter (OTC) sympathomimetic nasal spray. The complications (Clavien-Dindo classification IIIb) caused the necessity of recurrent hospitalizations and diagnostic interventions and an open conversion into Roux-Y gastric bypass in a damage control manner. Clinical discussion and conclusion Conclusively, we advocate evaluating drug abuse, including OTC medications that patients might not report on a daily-based medical history, as an etiology for marginal ulcers and anastomosis perforation, especially in late and recurrent cases. Abuse of OTC sympathomimetic nasal spray can cause recurrent gastrojejunal anastomosis ischemia. Re-Do surgery cannot prevent recurrence of ischemia in these cases. In recurrence of ischemia, detailed medical history, including OTC drugs, is crucial.
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Affiliation(s)
- Christian T J Magyar
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Gian A Prevost
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Philipp C Nett
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
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Munafò A, Frara S, Perico N, Di Mauro R, Cortinovis M, Burgaletto C, Cantarella G, Remuzzi G, Giustina A, Bernardini R. In search of an ideal drug for safer treatment of obesity: The false promise of pseudoephedrine. Rev Endocr Metab Disord 2021; 22:1013-1025. [PMID: 33945051 PMCID: PMC8724077 DOI: 10.1007/s11154-021-09658-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
Obesity is a major public health problem worldwide. Only relatively few treatment options are, at present, available for the management of obese patients. Furthermore, treatment of obesity is affected by the widespread misuse of drugs and food supplements. Ephedra sinica is an old medicinal herb, commonly used in the treatment of respiratory tract diseases. Ephedra species contain several alkaloids, including pseudoephedrine, notably endowed with indirect sympathomimetic pharmacodynamic properties. The anorexigenic effect of pseudoephedrine is attributable primarily to the inhibition of neurons located in the hypothalamic paraventricular nucleus (PVN), mediating satiety stimuli. Pseudoephedrine influences lipolysis and thermogenesis through interaction with β3 adrenergic receptors and reduces fat accumulation through down-regulation of transcription factors related to lipogenesis. However, its use is associated with adverse events that involve to a large extent the cardiovascular and the central nervous system. Adverse events of pseudoephedrine also affect the eye, the intestine, and the skin, and, of relevance, sudden cardiovascular death related to dietary supplements containing Ephedra alkaloids has also been reported. In light of the limited availability of clinical data on pseudoephedrine in obesity, along with its significantly unbalanced risk/benefit profile, as well as of the psychophysical susceptibility of obese patients, it appears reasonable to preclude the prescription of pseudoephedrine in obese patients of any order and degree.
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Affiliation(s)
- Antonio Munafò
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences (IEMS), San Raffaele Vita-Salute University, Milano, Milano, Italy
| | - Norberto Perico
- Istituto Di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | | | - Chiara Burgaletto
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy
| | - Giuseppe Remuzzi
- Istituto Di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences (IEMS), San Raffaele Vita-Salute University, Milano, Milano, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences, University of Catania School of Medicine, Catania, Italy.
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Boitet R, de Gaalon S, Ducros A. Sindrome da vasocostrizione cerebrale reversibile. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tuncer I, Unsal U. Acute effect of pseudoephedrine on macular microcirculation in healthy subjects: an optical coherence tomography angiography study. Jpn J Ophthalmol 2021; 66:94-100. [PMID: 34279747 DOI: 10.1007/s10384-021-00859-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantitatively evaluate the acute effects of pseudoephedrine on the macular microvasculature using optical coherence tomography angiography (OCTA). STUDY DESIGN Randomized placebo-controlled clinical study. METHODS In this study, 60 right eyes of 60 healthy subjects were divided into 2 groups. The study group received 60 mg of pseudoephedrine and the control group received a placebo. All participants underwent OCTA at baseline and 1 h after oral intake. Superficial macular flow area, foveal avascular zone (FAZ), superficial macular vessel density, central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) were analyzed. RESULTS Baseline superficial macular flow area, FAZ area, superficial macular vessel density, CFT and SFCT measurements in the study and control groups showed no significant difference (p > 0.05 for all). Oral pseudoephedrine intake caused a significant reduction in superficial macular flow area, FAZ area, superficial macular vessel density and SFCT measurements when compared with baseline (p < 0.05 for all). However, there was no significant difference in CFT after oral pseudoephedrine intake (p > 0.05). CONCLUSION Oral pseudoephedrine intake causes a significant decrease in superficial macular blood flow and SFCT. Impairmant of macular microcirculation can be detected noninvasively and quantitavitely by OCTA.
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Affiliation(s)
- Ibrahim Tuncer
- Alfa Medical Center, 6244 St. No:1, Bornova, 35040, Izmir, Turkey.
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Methylphenidate-Induced Raynaud’s Phenomenon In Two Cases With Attention-Deficit/Hyperactivity Disorder. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.837023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Chen R, Zhang Y, Dou Z, Chen F, Xie K, Wang S. Data Sharing and Privacy in Pharmaceutical Studies. Curr Pharm Des 2021; 27:911-918. [PMID: 33438533 DOI: 10.2174/1381612827999210112204732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Abstract
Adverse drug events have been a long-standing concern for the wide-ranging harms to public health, and the substantial disease burden. The key to diminish or eliminate the impacts is to build a comprehensive pharmacovigilance system. Application of the "big data" approach has been proved to assist the detection of adverse drug events by involving previously unavailable data sources and promoting health information exchange. Even though challenges and potential risks still remain. The lack of effective privacy-preserving measures in the flow of medical data is the most important Accepted: one, where urgent actions are required to prevent the threats and facilitate the construction of pharmacovigilance systems. Several privacy protection methods are reviewed in this article, which may be helpful to break the barrier.
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Affiliation(s)
- Rufan Chen
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
| | - Yi Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zuochao Dou
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
| | - Feng Chen
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
| | - Kang Xie
- Key Lab of Information Network Security of Ministry of Public Security, the Third Research Institute of Ministry of Public Security, Shanghai, China
| | - Shuang Wang
- Department of Bioinformatics, Hangzhou Nuowei Information Technology Co., Ltd, Hangzhou, China
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Aghayari Sheikh Neshin S, Shahjouei S, Koza E, Friedenberg I, Khodadadi F, Sabra M, Kobeissy F, Ansari S, Tsivgoulis G, Li J, Abedi V, Wolk DM, Zand R. Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology. Front Cardiovasc Med 2021; 8:649922. [PMID: 33855053 PMCID: PMC8039152 DOI: 10.3389/fcvm.2021.649922] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
Since the early days of the pandemic, there have been several reports of cerebrovascular complications during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Numerous studies proposed a role for SARS-CoV-2 in igniting stroke. In this review, we focused on the pathoetiology of stroke among the infected patients. We pictured the results of the SARS-CoV-2 invasion to the central nervous system (CNS) via neuronal and hematogenous routes, in addition to viral infection in peripheral tissues with extensive crosstalk with the CNS. SARS-CoV-2 infection results in pro-inflammatory cytokine and chemokine release and activation of the immune system, COVID-19-associated coagulopathy, endotheliitis and vasculitis, hypoxia, imbalance in the renin-angiotensin system, and cardiovascular complications that all may lead to the incidence of stroke. Critically ill patients, those with pre-existing comorbidities and patients taking certain medications, such as drugs with elevated risk for arrhythmia or thrombophilia, are more susceptible to a stroke after SARS-CoV-2 infection. By providing a pictorial narrative review, we illustrated these associations in detail to broaden the scope of our understanding of stroke in SARS-CoV-2-infected patients. We also discussed the role of antiplatelets and anticoagulants for stroke prevention and the need for a personalized approach among patients with SARS-CoV-2 infection.
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Affiliation(s)
| | - Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Isabel Friedenberg
- Department of Biology, Pennsylvania State University, State College, PA, United States
| | | | - Mirna Sabra
- Neurosciences Research Center (NRC), Lebanese University/Medical School, Beirut, Lebanon
| | - Firas Kobeissy
- Program of Neurotrauma, Neuroproteomics and Biomarker Research (NNBR), University of Florida, Gainesville, FL, United States
| | - Saeed Ansari
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, United States
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States.,Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States
| | - Donna M Wolk
- Molecular and Microbial Diagnostics and Development, Diagnostic Medicine Institute, Laboratory Medicine, Geisinger Health System, Danville, PA, United States
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, United States
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18
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Grimaldi-Bensouda L, Begaud B, Benichou J, Nordon C, Dialla O, Morisot N, Hamon Y, Cottin Y, Serrano E, Abenhaim L, Touzé E. Decongestant use and the risk of myocardial infarction and stroke: a case-crossover study. Sci Rep 2021; 11:4160. [PMID: 33603081 PMCID: PMC7893034 DOI: 10.1038/s41598-021-83718-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Pharmacovigilance reports of cerebral and cardiovascular events in those who use decongestants have triggered alerts related to their use. We aimed to assess the risk of stroke and myocardial infarction (MI) associated with the use of decongestants. We conducted a nested case-crossover study of patients with incident stroke and MI identified in France between 2013 and 2016 in two systematic disease registries. Decongestant use in the three weeks preceding the event was assessed using a structured telephone interview. Conditional logistic multivariable models were used to estimate the odds of incident MI and stroke, also accounting for transient risk factors and comparing week 1 (index at-risk time window, immediately preceding the event) to week 3 (reference). Time-invariant risk factors were controlled by design. In total, 1394 patients with MI and 1403 patients with stroke, mainly 70 years old or younger, were interviewed, including 3.2% who used decongestants during the three weeks prior to the event (1.0% definite exposure in the index at-risk time window, 1.1% in the referent time window; adjusted odds ratio (aOR), 0.78; 95%CI, 0.43-1.42). Secondary analysis yielded similar results for individual events (MI/stroke). We observed no increased risk of MI or stroke for patients 70 years of age and younger without previous MI or stroke who used decongestants.
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Affiliation(s)
- Lamiae Grimaldi-Bensouda
- The PGRx Study Group, Paris, France.
- Service de Pharmacologie, Hôpital Raymond Poincaré, Groupe Hospitalier Paris-Ile de France Ouest, Assistance Publique- Hôpitaux de Paris, Paris, France.
- UFR des Sciences de La Santé, Université Paris-Saclay, Paris, France.
| | - Bernard Begaud
- Département de Pharmacologie Médicale, Equipe "Pharmaco-Epidémiologie et Impact des Médicaments sur Les Populations", Bordeaux Population Health Research Center INSERM U1219, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Jacques Benichou
- Hôpital Universitaire de Rouen, Rouen, France
- INSERM U1219, Bordeaux, France
| | - Clementine Nordon
- The PGRx Study Group, Paris, France
- GHU Paris Psychiatrie Et Neurosciences, Paris, France
- Laser Core Paris, Paris, France
| | | | | | | | - Yves Cottin
- Departement de Cardiologie, Centre Hospitalo-Universitaire de Dijon, Dijon, France
| | - Elie Serrano
- ORL Et Chirurgie Cervico-Faciale, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Lucien Abenhaim
- The PGRx Study Group, London, UK
- London School of Hygiene and Tropical Medicine and Laser Core UK, London, UK
| | - Emmanuel Touzé
- Normandie Université, Université Caen Normandie, CHU Caen Normandie, Inserm U1237, Caen, France
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19
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Nadjidai SE, Kusljic S, Dowling NL, Magennis J, Stokes L, Ng CH, Daniel C. Physical comorbidities in private psychiatric inpatients: Prevalence and its association with quality of life and functional impairment. Int J Ment Health Nurs 2020; 29:1253-1261. [PMID: 32677324 DOI: 10.1111/inm.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the association between physical health conditions and quality of life and functioning in private psychiatric inpatients. We sought to determine whether quality of life and functioning was poorer in individuals with physical comorbidity compared to those without. A quantitative correlational descriptive design was utilized. Seventy patients were included in sequential order within a week of admission to hospital. Participants completed the SF-36 survey, and the corresponding hospital records were audited. The STROBE guidelines were followed in the reporting of this research. The study found that 64.3% (45/70) of participants had one or more comorbid physical health conditions, primarily cardiovascular, respiratory, musculoskeletal, endocrine and medically unexplained conditions or syndromes. Chronic pain was experienced by 40% (28/70) of participants, and 47.6% (33/70) were found to be overweight or obese. Tobacco smoking and obesity were risk factors associated with physical comorbidity (P = 0.02 and P < 0.001, respectively). Quality of life and functioning were poorer in those with physical health conditions, particularly in the SF-36 domains of bodily pain, physical functioning and general health (P < 0.001, P = 0.003 and P = 0.005, respectively). Physical health conditions were largely prevalent, and quality of life and functioning were poorer in those with physical comorbidities. The implementation of clinical guidelines for the monitoring of physical health has been proposed as well as a dedicated physical health nursing role. Continuation of integrative programmes focusing on both physical and mental health may also benefit patients in this setting.
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Affiliation(s)
- Sarah E Nadjidai
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Snezana Kusljic
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Nathan L Dowling
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lisa Stokes
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.,The Melbourne Clinic, Melbourne, Victoria, Australia
| | - Chee H Ng
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Daniel
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Houlihan LM, Halloran PJO, Lynch J, Widdess-Walsh P, Brennan P, Javadpour M. Reversible cerebral vasoconstrictive syndrome preceded by minor head trauma. Br J Neurosurg 2020; 34:647-649. [DOI: 10.1080/02688697.2019.1672858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- L. M. Houlihan
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. J. O' Halloran
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J. Lynch
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. Widdess-Walsh
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P. Brennan
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M. Javadpour
- Departments of Neurosurgery, Neurology and Neuroradiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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21
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Patel J, Patel I, Desai D, Desai S. Ischemic Stroke Associated with Chronic Xylometazoline Nasal Spray Misuse: A Rare Avoidable Adverse Event. Ann Indian Acad Neurol 2020; 24:304-307. [PMID: 34220102 PMCID: PMC8232514 DOI: 10.4103/aian.aian_291_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jalpan Patel
- Physician Doctor, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Ishani Patel
- Physician Doctor, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Devangi Desai
- Professor in Medicine Department, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
| | - Soaham Desai
- Sr. Consultant Neurologist, Professor and Head, Neurology, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
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22
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Wilmshurst PT. Immersion pulmonary oedema: a cardiological perspective. Diving Hyperb Med 2019; 49:30-40. [PMID: 30856665 DOI: 10.28920/dhm49.1.30-40] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/14/2019] [Indexed: 12/17/2022]
Abstract
It is postulated that immersion pulmonary oedema (IPE) occurs because of combinations of factors that each increase the hydrostatic pressure gradient between the pulmonary capillaries and the alveoli. The factors, by definition, include the effects of immersion, particularly raised central blood volume and hence cardiac filling pressures. Breathing against a negative pressure is important but the magnitude of the effect depends on the relation of the diver's lung centroid to the source of the breathing gas and the breathing characteristics of diving equipment. Other factors are cold-induced vasoconstriction, exertion and emotional stress, but variations of the responses of individuals to these stimuli are important. Hypertension is the most frequent cardiovascular disease predisposing to IPE but other medical conditions are implicated in some patients.
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Affiliation(s)
- Peter T Wilmshurst
- Corresponding author: Royal Stoke University Hospital, Stoke-on-Trent, ST4 6QG, United Kingdom,
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23
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 571] [Impact Index Per Article: 114.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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24
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Loomes K, Anderson J. Intra‐splenic administration of phenylephrine in a horse to induce splenic contraction in a case of nephrosplenic entrapment of the large colon non‐responsive to intravenous phenylephrine administration. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K. Loomes
- Rainbow Equine Hospital Malton North Yorkshire UK
| | - J. Anderson
- Rainbow Equine Hospital Malton North Yorkshire UK
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25
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Mladěnka P, Applová L, Patočka J, Costa VM, Remiao F, Pourová J, Mladěnka A, Karlíčková J, Jahodář L, Vopršalová M, Varner KJ, Štěrba M. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev 2018; 38:1332-1403. [PMID: 29315692 PMCID: PMC6033155 DOI: 10.1002/med.21476] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/20/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are a leading cause of morbidity and mortality in most developed countries of the world. Pharmaceuticals, illicit drugs, and toxins can significantly contribute to the overall cardiovascular burden and thus deserve attention. The present article is a systematic overview of drugs that may induce distinct cardiovascular toxicity. The compounds are classified into agents that have significant effects on the heart, blood vessels, or both. The mechanism(s) of toxic action are discussed and treatment modalities are briefly mentioned in relevant cases. Due to the large number of clinically relevant compounds discussed, this article could be of interest to a broad audience including pharmacologists and toxicologists, pharmacists, physicians, and medicinal chemists. Particular emphasis is given to clinically relevant topics including the cardiovascular toxicity of illicit sympathomimetic drugs (e.g., cocaine, amphetamines, cathinones), drugs that prolong the QT interval, antidysrhythmic drugs, digoxin and other cardioactive steroids, beta-blockers, calcium channel blockers, female hormones, nonsteroidal anti-inflammatory, and anticancer compounds encompassing anthracyclines and novel targeted therapy interfering with the HER2 or the vascular endothelial growth factor pathway.
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Affiliation(s)
- Přemysl Mladěnka
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Lenka Applová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Jiří Patočka
- Department of Radiology and Toxicology, Faculty of Health and Social StudiesUniversity of South BohemiaČeské BudějoviceCzech Republic
- Biomedical Research CentreUniversity HospitalHradec KraloveCzech Republic
| | - Vera Marisa Costa
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Fernando Remiao
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Jana Pourová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Aleš Mladěnka
- Oncogynaecologic Center, Department of Gynecology and ObstetricsUniversity HospitalOstravaCzech Republic
| | - Jana Karlíčková
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Luděk Jahodář
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Marie Vopršalová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Kurt J. Varner
- Department of PharmacologyLouisiana State University Health Sciences CenterNew OrleansLAUSA
| | - Martin Štěrba
- Department of Pharmacology, Faculty of Medicine in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
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26
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Abstract
This paper summarizes the currently accepted concepts of the pathogenetic mechanisms underlying the morphological and functional changes in intranasal mucosa of the patients having a long history of the application of the long-acting topical vasoconstrictor agents. The author presents the data illustrating the effectiveness of various methods for the pharmacotherapeutic treatment of medically-induced rhinitis.
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Affiliation(s)
- E V Nosulya
- Department of Otorhinolaryngology, Russian Medical Academy of Continuous Post-Graduate Education, Moscow, Russia, 125367
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27
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Goldhammer JE, Dobish MA, McAnulty JT, Smaka TJ, Epstein RH. Intranasal Medication Administration Using a Squeeze Bottle Atomizer Results in Overdosing if Deployed in Supine Patients. Anesth Analg 2017; 125:453-457. [PMID: 27828797 DOI: 10.1213/ane.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Vasoconstrictors and local anesthetics are commonly administered using a squeeze bottle atomizer to the nasal mucosa to reduce edema, limit bleeding, and provide analgesia. Despite widespread use, there are few clinical guidelines that address technical details related to safe administration. The purpose of this study was to quantify, via simulation, the amount of liquid delivered to the nasal mucosa when patients are in the supine and upright positions and administration parameters that would reliably provide the desired amount of medication per spray. METHODS A convenience sample of 10 anesthesia residents was studied. Providers were instructed to use a 25-mL dip and tube nasal squeeze bottle to administer the test solution (sterile water) to a mannequin in the upright (90° elevation) and supine (0° elevation) position. After mannequin testing, additional testing was completed with the spray bottles at 0°, 15°, 30°, 45°, and 90° to determine the relationship between the angles of administration and the amount of liquid dispensed. RESULTS The mean volume delivered per spray was substantially greater when administered in the supine position (0.56 ± 0.22 mL) compared with the upright position (0.041 ± 0.02 mL, difference = 0.52 mL, 95% confidence interval [CI], 0.37-0.67 mL, P < .001). Converting the administered volume to the dose of phenylephrine that would be administered using our standard 0.25% solution, an estimated additional 1300 mcg is delivered per spray in the supine position compared with the upright position (95% CI, 925-1675 mcg, P < .001). Administration with a delivery angle of ≤30° resulted in significantly more volume than when the bottle was oriented at a 90° angle. The volume dispensed at 45° was not different from the volume delivered at 90° (0.032 ± 0.006 mL vs 0.030 ± 0.005 mL, P = .34). CONCLUSIONS We found a 14-fold increase in the volume (ie, dose) delivered per spray when a nasal squeeze bottle was used with a mannequin in the supine position compared with the upright position. Given the reported toxicity from the use of intranasal medication and the inadvertent overdosing that occurs when squeeze bottle atomizers are used in clinical practice, our data suggest that all intranasal drugs should be administered with a precise, metered-dose device. If a metered-dose device is unavailable, the medication should be delivered at an angle of ≥45°; however, we recommend administering the drug with the patient in the sitting position and the bottle at 90° because only a small change in angle below 45° will result in a substantial increase in medication delivered.
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Affiliation(s)
- Jordan E Goldhammer
- From the *Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; and †the Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miller School of Medicine, University of Miami, Miami, Florida
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28
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Kalladka D, Siddiqui A, Tyagi A, Newman E. Reversible cerebral vasoconstriction syndrome secondary to caffeine withdrawal. Scott Med J 2017; 63:22-24. [PMID: 28480791 DOI: 10.1177/0036933017706892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a 39-year-old man who developed thunderclap headaches during a hospital admission for accidental superficial burns. His magnetic resonance brain imaging was normal expect for diffuse segmental vasoconstriction. Prior to admission, he was consuming excessive amounts of caffeine which was restarted and slowly tapered and stopped over weeks. Repeat magnetic resonance angiogram showed resolution of segmental vasoconstriction. The implications of prescribed and non-prescribed drugs on cerebral vasculature have been discussed.
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Affiliation(s)
- Dheeraj Kalladka
- 1 DK, Neurology Registrar/Stroke Fellow AT & EN, Consultant Neurologists, Department of Neurology, Queen Elizabeth University Hospital, UK
| | - Aslam Siddiqui
- 2 AS, Consultant Neuroradiologist, Department of Neuroradiology, Queen Elizabeth University Hospital, UK
| | - Alok Tyagi
- 1 DK, Neurology Registrar/Stroke Fellow AT & EN, Consultant Neurologists, Department of Neurology, Queen Elizabeth University Hospital, UK
| | - Edward Newman
- 1 DK, Neurology Registrar/Stroke Fellow AT & EN, Consultant Neurologists, Department of Neurology, Queen Elizabeth University Hospital, UK
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29
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Kupferman JC, Zafeiriou DI, Lande MB, Kirkham FJ, Pavlakis SG. Stroke and Hypertension in Children and Adolescents. J Child Neurol 2017; 32:408-417. [PMID: 28019129 DOI: 10.1177/0883073816685240] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hypertension is the single most important modifiable risk factor for adult stroke. Stroke mortality has significantly decreased over the last 5 decades; this decline has been mainly associated to improved blood pressure control. Though much less prevalent than in adults, stroke is an increasingly recognized cause of morbidity and mortality in children. Although hypertension has not been strongly identified as a risk factor in childhood stroke yet, there is preliminary evidence that suggests that elevated blood pressure may be associated with stroke in children. This review summarizes the literature that may link elevated blood pressure to the development of childhood ischemic and hemorrhagic stroke. The authors suggest that elevated blood pressure may be a significant risk factor that, alone or in combination with other multiple risk factors, leads to the development of stroke in childhood. It is therefore recommend that blood pressure be measured and assessed carefully in every child presenting with acute stroke.
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Affiliation(s)
- Juan C Kupferman
- 1 Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA
| | - Dimitrios I Zafeiriou
- 2 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marc B Lande
- 3 Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Fenella J Kirkham
- 4 Developmental Neuroscience, UCL Institute of Child Health, London, United Kingdom
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30
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Topcuoglu MA, Jha RM, George J, Frosch MP, Singhal AB. Hemorrhagic primary CNS angiitis and vasoconstrictive drug exposure. Neurol Clin Pract 2017; 7:26-34. [PMID: 28243503 DOI: 10.1212/cpj.0000000000000324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary angiitis of the CNS (PACNS) typically manifests with accumulating neurologic deficits from ischemic strokes. Intracerebral hemorrhage (ICH) is an uncommon complication. There is limited knowledge about the risk factors and features of hemorrhagic PACNS. METHODS We identified 49 patients (20 biopsy-proven) with PACNS diagnosed at our hospital from 1993 to 2015. We compared the features of hemorrhagic and nonhemorrhagic PACNS and analyzed the hemorrhagic PACNS cases in detail. RESULTS The mean age was 51 ± 15 years; 13 patients were men. Five patients had ICH (mean age 52 ± 14 years; 4 men) including 4 where ICH was the first manifestation of PACNS. All ICH patients reported recent exposure to sympathomimetic drugs (e.g., diet pills, nasal decongestants). Patients with ICH had higher rates of headache (100% vs 43%, p = 0.022), especially thunderclap headache (60% vs 0%, p = 0.001), and eosinophilic vascular infiltrates on brain biopsy (50% vs 9%, p = 0.084). In all ICH patients, brain MRI showed lobar hemorrhages with concurrent punctate diffusion-restricted lesions, suggesting an acute inflammatory process. Four received a short course of immunosuppressive therapy. All patients showed complete clinical resolution or significant improvement within weeks. CONCLUSIONS In this study, hemorrhagic PACNS was exclusively associated with sympathomimetic drug exposure. The high rate of thunderclap headache, lobar hemorrhages, and the self-limited clinical course suggests a shared mechanism between hemorrhagic PACNS and the reversible cerebral vasoconstriction syndrome (RCVS), a PACNS mimic. This RCVS-PACNS overlap syndrome may result from sympathomimetic drug-induced prolonged distal vasoconstriction, culminating in inflammation.
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Affiliation(s)
- Mehmet A Topcuoglu
- Massachusetts General Hospital and Harvard Medical School (MAT, MPF, ABS), Boston; Neurology Department (MAT), Hacettepe University Hospitals, Ankara, Turkey; Safar Center for Resuscitation (RMJ), University of Pittsburgh Medical Center, PA; and Government Medical College (JG), Kottayam, India
| | - Ruchira M Jha
- Massachusetts General Hospital and Harvard Medical School (MAT, MPF, ABS), Boston; Neurology Department (MAT), Hacettepe University Hospitals, Ankara, Turkey; Safar Center for Resuscitation (RMJ), University of Pittsburgh Medical Center, PA; and Government Medical College (JG), Kottayam, India
| | - Jacob George
- Massachusetts General Hospital and Harvard Medical School (MAT, MPF, ABS), Boston; Neurology Department (MAT), Hacettepe University Hospitals, Ankara, Turkey; Safar Center for Resuscitation (RMJ), University of Pittsburgh Medical Center, PA; and Government Medical College (JG), Kottayam, India
| | - Matthew P Frosch
- Massachusetts General Hospital and Harvard Medical School (MAT, MPF, ABS), Boston; Neurology Department (MAT), Hacettepe University Hospitals, Ankara, Turkey; Safar Center for Resuscitation (RMJ), University of Pittsburgh Medical Center, PA; and Government Medical College (JG), Kottayam, India
| | - Aneesh B Singhal
- Massachusetts General Hospital and Harvard Medical School (MAT, MPF, ABS), Boston; Neurology Department (MAT), Hacettepe University Hospitals, Ankara, Turkey; Safar Center for Resuscitation (RMJ), University of Pittsburgh Medical Center, PA; and Government Medical College (JG), Kottayam, India
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Abstract
Phenylpropanolamine-induced vasculitis and related intracerebral hemorrhage has moved from the spotlight it occupied following its withdrawal from the market at the end of 2000 after the Food and Drug Administration ruled that it was not safe and effective, but the risk from medicines purchased prior to that time and still in the possession of the public can still pose a health hazard. We present the case of a patient who developed intracerebral hemorrhage following phenylpropanolamine ingestion post-partum 4 years following the recall, as well as her difficult recovery process. This case emphasizes the point that physicians should consider phenylpropanolamine when evaluating young females with few risk factors for stroke.
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Stroke from Vasospasm due to Marijuana Use: Can Cannabis Synergistically with Other Medications Trigger Cerebral Vasospasm? Case Rep Neurol Med 2016; 2016:5313795. [PMID: 27833768 PMCID: PMC5090067 DOI: 10.1155/2016/5313795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/09/2016] [Accepted: 09/18/2016] [Indexed: 11/18/2022] Open
Abstract
We present a case of imaging proven cerebral vasospasm causing ischemic stroke in a young patient chronically on buprenorphine-naloxone for heroin remission who started smoking cannabis on a daily basis. With cannabis legalization spreading across the states in the USA, it is important for physicians not only to be aware of cannabis reported association with cerebral vasospasm in some patients but also to be on the lookout for possible interacting medications that can synergistically affect cerebral vessels causing debilitating strokes.
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Medico-legal perspectives on sudden cardiac death in young athletes. Int J Legal Med 2016; 131:393-409. [PMID: 27654714 DOI: 10.1007/s00414-016-1452-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/08/2016] [Indexed: 01/11/2023]
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Page RL, O'Bryant CL, Cheng D, Dow TJ, Ky B, Stein CM, Spencer AP, Trupp RJ, Lindenfeld J. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e32-69. [PMID: 27400984 DOI: 10.1161/cir.0000000000000426] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients.
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Dal Corso E, Bondiani AL, Zanolla L, Vassanelli C. Nurse Educational Activity on Non-Prescription Therapies in Patients with Chronic Heart Failure. Eur J Cardiovasc Nurs 2016; 6:314-20. [PMID: 17512802 DOI: 10.1016/j.ejcnurse.2007.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Revised: 03/25/2007] [Accepted: 04/05/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Notwithstanding the polypharmacy required for heart failure therapy, many patients use non-prescription therapies, including alternative medicines, herbal remedies, integrators and over-the-counter (OTC) drugs. AIMS Non-prescription therapies could interfere with heart failure therapy, both promoting non-compliance and through pharmacological interferences. Heart failure nurses, in order to plan their educational activity, need to known about the use of therapies other than prescription. METHODS The use of non-prescription therapies was assessed by a structured interview in 153 chronic patients with heart failure. RESULTS Only 15.7% patients exclusively used medicines prescribed by their physicians. Alternative medicine use was not frequent (5.8%), herbal remedies (21.3%) and integrators (20.9%) were more used; OTC drugs were most common, with 75.8% use. Patients were often unaware of possible interaction with heart failure therapies, and seldom informed physician of use. CONCLUSIONS Advice about drugs avoidance is emphasized by heart failure guidelines, and is part of the nurse educational activity. More attention should be paid to OTC drug assessment and education since their use is common.
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Affiliation(s)
- Elena Dal Corso
- Divisione Clinicizzata di Cardiologia - Azienda Ospedaliera Istituti Ospitalieri Verona - Piazzale Stefani 1 - 37126 Verona, Italy
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Wolff V. Angiopatie cerebrali tossiche. Neurologia 2016. [DOI: 10.1016/s1634-7072(15)76143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Fullerton HJ, Hills NK, Elkind MSV, Dowling MM, Wintermark M, Glaser CA, Tan M, Rivkin MJ, Titomanlio L, Barkovich AJ, deVeber GA. Infection, vaccination, and childhood arterial ischemic stroke: Results of the VIPS study. Neurology 2015; 85:1459-66. [PMID: 26423434 DOI: 10.1212/wnl.0000000000002065] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/15/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Minor infection can trigger adult arterial ischemic stroke (AIS) and is common in childhood. We tested the hypotheses that infection transiently increases risk of AIS in children, regardless of stroke subtype, while vaccination against infection is protective. METHODS The Vascular Effects of Infection in Pediatric Stroke study is an international case-control study that prospectively enrolled 355 centrally confirmed cases of AIS (29 days-18 years old) and 354 stroke-free controls. To determine prior exposure to infections and vaccines, we conducted parental interviews and chart review. RESULTS Median (interquartile range) age was 7.6 years for cases and 9.3 for controls (p = 0.44). Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases, vs 3% of controls, conferring a 6.3-fold increased risk of AIS (p < 0.0001); upper respiratory infections were most common. Prevalence of preceding infection was similar across stroke subtypes: arteriopathic, cardioembolic, and idiopathic. Use of vasoactive cold medications was similarly low in both groups. Children with some/few/no routine vaccinations were at higher stroke risk than those receiving all or most (odds ratio [OR] 7.3, p = 0.0002). In an age-adjusted multivariate logistic regression model, independent risk factors for AIS included infection in the prior week (OR 6.3, p < 0.0001), undervaccination (OR 8.2, p = 0.0004), black race (compared to white; OR 1.9, p = 0.009), and rural residence (compared to urban; OR 3.0, p = 0.0003). CONCLUSIONS Infection may act as a trigger for childhood AIS, while routine vaccinations appear protective. Hence, efforts to reduce the spread of common infections might help prevent stroke in children.
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Affiliation(s)
- Heather J Fullerton
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada.
| | - Nancy K Hills
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Mitchell S V Elkind
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Michael M Dowling
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Max Wintermark
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Carol A Glaser
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Marilyn Tan
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Michael J Rivkin
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Luigi Titomanlio
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - A James Barkovich
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
| | - Gabrielle A deVeber
- From the Departments of Neurology (H.J.F., N.K.H., A.J.B.), Pediatrics (H.J.F., C.A.G., A.J.B.), Biostatistics and Epidemiology (N.K.H.), and Radiology (A.J.B.), University of California San Francisco; the Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY; the Departments of Pediatrics and Neurology and Neurotherapeutics (M.M.D.), UT Southwestern Medical Center, Dallas, TX; the Department of Radiology (M.W.), Stanford University, Palo Alto, CA; the Division of Communicable Disease Control (C.A.G.), Center for Infectious Diseases, California Department of Public Health, Richmond; the Departments of Pediatrics and Neurosciences (M.T.), University of the Philippines-Philippine General Hospital, Manila, Philippines; the Departments of Neurology, Psychiatry, and Radiology (M.J.R.), Boston Children's Hospital, MA; the Pediatric Emergency Department (L.T.), Robert Debré Hospital, Paris Diderot University, Paris, France; and the Department of Neurology (G.A.d.), Hospital for Sick Children, Toronto, Canada
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Kobayashi M. Diffuse cerebrovascular dilation: Case report of amezinium metilsulfate-induced reversible cerebral vasoconstriction syndrome. Cephalalgia 2015; 36:289-93. [PMID: 26016487 DOI: 10.1177/0333102415588326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches with reversible cerebral vasoconstriction, and often precipitated by the postpartum state and vasoactive medications. We describe a case of a patient with RCVS induced by amezinium metilsulfate, a sympathomimetic drug, in whom magnetic resonance angiography (MRA) initially revealed diffusely dilated cerebral arteries. CASE DESCRIPTION A 34-year-old woman was prescribed amezinium metilsulfate for hypotension. Twelve days later, she suffered from abrupt severe headaches and was referred to our department. She had no neurological deficits; however, MRA revealed diffusely dilated anterior, middle, and posterior cerebral arteries with vasoconstriction. She was tentatively diagnosed with RCVS and successfully treated with verapamil for headache. Nevertheless, follow-up MRAs disclosed widespread segmental vasoconstriction that resolved in two months. DISCUSSION Diffuse cerebrovascular dilation has not been addressed but may be associated with RCVS pathophysiology. In addition, physicians should bear in mind that amezinium metilsulfate can potentially induce RCVS.
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Potential cardiovascular adverse events when phenylephrine is combined with paracetamol: simulation and narrative review. Eur J Clin Pharmacol 2015; 71:931-8. [PMID: 26022219 PMCID: PMC4500855 DOI: 10.1007/s00228-015-1876-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/20/2015] [Indexed: 11/23/2022]
Abstract
Background Increased bioavailability of phenylephrine is reported when combined with paracetamol in over-the-counter formulations for the symptomatic treatment of the common cold and influenza. Such formulations could increase phenylephrine-related cardiovascular adverse events particularly in susceptible individuals. Quantification of the effect of phenylephrine concentration on blood pressure allows simulation of potential adverse combination therapy effects. Methods MEDLINE and EMBASE databases were searched for papers discussing or describing any adverse effect, hypersensitivity or safety concerns related to phenylephrine alone or in combination with other drugs. The pharmacodynamic relationship between plasma phenylephrine concentration and mean arterial blood pressure was characterized using published observations of blood pressure changes after ophthalmic eye drops. The resulting pharmacokinetic and pharmacodynamic parameters were then used to predict mean arterial blood pressure (MAP) changes in that population if given an oral combination of phenylephrine and paracetamol. Results There were 1172 papers identified for examination. Forty-seven reports fulfilled the inclusion criteria. Increases in blood pressure and decreases in heart rate have been reported with doses over 15 mg. It has been estimated that a 20-mmHg increase in systolic blood pressure would occur with an oral dose of 45 mg phenylephrine in normotensive healthy people. Those taking monoamine oxidase inhibitors report increased systolic blood pressure of greater than 60 mmHg. Blood pressure and heart rate changes are potentiated in patients with underlying hypertension. Simulation showed a modest increase in MAP when phenylephrine 10 mg was co-administered with paracetamol 1 g (4.2 vs 12.3 mmHg). Conclusions Combination paracetamol phenylephrine oral therapy has potential to increase blood pressure more than phenylephrine alone in those with cardiovascular compromise. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1876-1) contains supplementary material, which is available to authorized users.
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Laccourreye O, Werner A, Giroud JP, Couloigner V, Bonfils P, Bondon-Guitton E. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:31-4. [DOI: 10.1016/j.anorl.2014.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mhatre SK, Sansgiry SS. Assessing a conceptual model of over-the-counter medication misuse, adverse drug events and health-related quality of life in an elderly population. Geriatr Gerontol Int 2015; 16:103-10. [PMID: 25613189 DOI: 10.1111/ggi.12443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 01/31/2023]
Abstract
AIM The objectives of the present study were to test Spilker's quality of life model in the elderly population consuming over-the-counter (OTC) medications. It was hypothesized that OTC medication misuse increases adverse drug events (ADEs), ADEs as a result of OTC medication misuse decrease health-related quality of life (HRQoL) and the impact of OTC medication misuse on patients' HRQoL is fully medicated by ADEs associated with OTC medications. METHODS Data were used from a previously carried out cross-sectional study using survey instruments with elderly patients consuming OTC medications in Houston, Texas, USA. The presence/absence of OTC misuse was assessed by an expert panel based on patient reported information on drug use characteristics; ADE was self-reported and HRQoL was measured using the Short Form-12v2, which contains a physical component summary score (PCS) and a mental component summary score (MCS). RESULTS Of the 154 respondents, 18.2% misused OTC medications and 22.1% reported ADE as a result of OTC medications. The mean ± SD score of PCS and MCS was 40.6 ± 6.8 and 46.4 ± 7, respectively. The hypothesized framework provided a well-fitted solution to the data (χ(2) = 1.387, d.f. = 2, P = 0.49; weighted root mean square residual = 0.317). Misuse of OTC medications significantly increased ADEs associated with OTC medications (β = 0.298) and increased ADEs significantly decreased patient reported PCS (β = -0.312), but not MCS (β = -0.213). OTC medication misuse indirectly decreased PCS and MCS by mediating the effect of an increase in ADE; however, the association was not statistically significant. CONCLUSIONS Misuse of OTC medications is highly associated with ADEs. ADEs are capable of decreasing the physical health of elderly patients.
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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course. AJNR Am J Neuroradiol 2015; 36:1392-9. [PMID: 25593203 DOI: 10.3174/ajnr.a4214] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reversible cerebral vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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Baker SK, Silva JE, Lam KKS. Pseudoephedrine-induced Hemorrhage Associated with a Cerebral Vascular Malformation. Can J Neurol Sci 2014; 32:248-52. [PMID: 16018164 DOI: 10.1017/s0317167100004066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT:Background:Sympathomimetic-related intracerebral hemorrhage is well-documented. Most cases are associated with phenylpropanolamine use.Case Report:We report a case of intracerebral hemorrhage occurring in a middle-aged man who suffered from chronic sinusitis and had been ingesting pseudoephedrine daily for one year. This patient was previously well with no known cardiovascular risk factors. Clinical examination revealed no evidence of vasculitis nor coagulopathy and initial neuroimaging (i.e., computed tomography, angiography, magnetic resonance imaging) demonstrated no features consistent with aneurysm, arteriovenous malformation (AVM), cavernoma, nor cerebral metastases. A follow-up cerebral angiogram demonstrated a small AVM arising off a branch of the pericallosal artery and a small arteriovenous fistula arising off the costal marginal branch. The AVM was embolized without incident, however, the AVF was not accessible.Conclusions:Sympathomimetics have long been associated with intracerebral hemorrhage. Since 1979, over 30 published case reports have documented the relationship between phenylpropanolamine and stroke. Only one report links phenylpropanolamine consumption to an intracerebral hemorrhage in a patient with an AVM. There is a paucity of literature etiologically inculpating other ephedra alkaloids in the causation of intracerebral hemorrhage. This is a case of pseudoephedrine-induced intracerebral hemorrhage in a patient with an underlying vascular malformation.
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Affiliation(s)
- Steven K Baker
- Department of Medicine (Neurology & Rehabilitation), McMaster University, Hamilton, Ontario, Canada
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Tark BE, Messe SR, Balucani C, Levine SR. Intracerebral hemorrhage associated with oral phenylephrine use: a case report and review of the literature. J Stroke Cerebrovasc Dis 2014; 23:2296-300. [PMID: 25156786 DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/02/2014] [Accepted: 04/05/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prior reports have linked both ischemic and hemorrhagic stroke to use of sympathomimetic drugs including phenylephrine. The purpose of this study is to describe the first case, to our knowledge of intracerebral hemorrhage (ICH) after oral use of phenylephrine and to systematically review the literature on phenylephrine and acute stroke. METHODS A case report and review of the literature. RESULTS A 59-year-old female presented with thunderclap headache, right hemiparesis, aphasia, and left gaze deviation. Head computed tomography (CT) showed a left frontal ICH with intraventricular and subarachnoid extension. She had no significant past medical history. For the previous 30 days, the patient was taking multiple common cold remedies containing phenylephrine to treat sinusitis. CT and magnetic resonance angiography showed no causative vascular abnormality. Catheter cerebral angiography supported reversible cerebral vasoconstriction syndrome (RCVS). Phenylephrine was determined to be the most likely etiology for her hemorrhage. A review of the literature, found 7 cases describing phenylephrine use with acute stroke occurrence: female, 5 of 7 (71%); route of administration, nasal (n = 3), ophthalmic (n = 2), intravenous (n = 1), intracorporeal injection (n = 1). Stroke types were subarachnoid hemorrhage (n = 5), ICH (n = 4), and ischemic (n = 1). One case reported RCVS after phenylephrine use. CONCLUSIONS It is scientifically plausible that phenylephrine may cause strokes, consistent with the pharmacologic properties and adverse event profiles of similar amphetamine-like sympathomimetics. As RCVS has been well described in association with over-the-counter sympathomimetics, a likely, although not definitive, causal relationship between phenylephrine and ICH is proposed.
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Affiliation(s)
- Brian E Tark
- Department of Neurology and Stroke Center, SUNY Downstate Medical Center, Brooklyn, New York
| | - Steven R Messe
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clotilde Balucani
- Department of Neurology and Stroke Center, SUNY Downstate Medical Center, Brooklyn, New York
| | - Steven R Levine
- Department of Neurology and Stroke Center, SUNY Downstate Medical Center, Brooklyn, New York; Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York.
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Mehdi A, Hajj-Ali RA. Reversible Cerebral Vasoconstriction Syndrome: a Comprehensive Update. Curr Pain Headache Rep 2014; 18:443. [DOI: 10.1007/s11916-014-0443-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moussouttas M, Lai EW, Huynh TT, James J, Stocks-Dietz C, Dombrowski K, Khoury J, Pacak K. Association between acute sympathetic response, early onset vasospasm, and delayed vasospasm following spontaneous subarachnoid hemorrhage. J Clin Neurosci 2014; 21:256-62. [DOI: 10.1016/j.jocn.2013.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 03/26/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
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Mathon B, Ducros A, Bresson D, Herbrecht A, Mirone G, Houdart E, Saint-Maurice JP, Di Emidio P, George B, Chibbaro S. Subarachnoid and intra-cerebral hemorrhage in young adults: rare and underdiagnosed. Rev Neurol (Paris) 2014; 170:110-8. [PMID: 24411684 DOI: 10.1016/j.neurol.2013.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/03/2013] [Accepted: 07/19/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Convexity subarachnoid and intra-cerebral hemorrhages, in patients aged<50 years, are always a diagnostic challenge. This condition is characterized by acute headaches with or without neurological symptoms and/or seizures, and by the radiological demonstration of subarachnoid and/or intra-cerebral hemorrhages and, more rarely, by the association of ischemic events. PATIENTS AND METHODS In a prospective series of 30 consecutive patients (median age 31 years; 22 women) with a subarachnoid and intra-cerebral hemorrhages, 19 were diagnosed with reversible cerebral vasoconstriction syndrome (RCVS), 7 with cerebral venous sinus thrombosis (CVST), and 4 with a bleeding mycotic aneurysm (MA). RESULTS RCVS appeared spontaneously in 16 patients and was related to the postpartum period in three cases. Subarachnoid hemorrhage (SAH) was demonstrated in 24 patients as follows: 18 cases were in cortical areas, 4 were in the polygon of Willis, one was inter-hemispheric, and one was inter-hemispheric/intra-cerebral. A convexity pure intra-cerebral hemorrhage (ICH) was recorded in 6 cases. Among the 7 patients suffering from CVST, the superior sagittal sinus was involved in 4 cases, the transverse sinuses (TS) in 2, and the TS plus sigmoid sinus (SS) in one. CONCLUSION The three most common causes in this series were RCVS, followed by CVST and bleeding from MA. Because of atypical clinical or radiological presentations, this large spectrum of etiologies can cause diagnostic difficulties. Therefore, careful analysis is needed to ensure correct and prompt diagnosis and to avoid any dangerous delays in management.
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Affiliation(s)
- B Mathon
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - A Ducros
- Service de neurologie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - D Bresson
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Herbrecht
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - G Mirone
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - E Houdart
- Service de neuroradiologie interventionnelle, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - J-P Saint-Maurice
- Service de neuroradiologie interventionnelle, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - P Di Emidio
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - B George
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - S Chibbaro
- Service de neurochirurgie, CHU Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
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Abstract
Reversible cerebral vasoconstriction syndrome is characterized by severe headaches with or without focal neurologic deficits and/or seizures, and segmental constriction of cerebral arteries that resolves within 3 months. This increasingly recognized syndrome is supposedly due to a transient disturbance in the control of cerebral vascular tone with sympathetic overactivity. It can cause stroke in the young. It affects mainly middle-aged women. More than half the cases occur after exposure to vasoactive substances or during postpartum. The manifestations have a monophasic course, without new clinical symptom after 4 weeks, and range from pure cephalalgic forms with recurrent thunderclap headaches over 1-2 weeks to rare catastrophic forms with multiple hemorrhagic and ischemic strokes, brain edema and death. Diagnosis may be hampered by the dynamic nature of clinicoradiological features. Convexity subarachnoid hemorrhage or stroke may occur a few days after initial normal imaging, and cerebral vasoconstriction is maximal on angiography 2-3 weeks after clinical onset. Symptomatic treatment includes rest and removal of vasoactive substances. Nimodipine has been proposed to reduce thunderclap headaches within 48 hours, but has no proven effect on the hemorrhagic and ischemic complications.
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Affiliation(s)
- Anne Ducros
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France.
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Sotomayor-Zárate R, Jara P, Araos P, Vinet R, Quiroz G, Renard GM, Espinosa P, Hurtado-Guzmán C, Moya PR, Iturriaga-Vásquez P, Gysling K, Reyes-Parada M. Improving Amphetamine Therapeutic Selectivity:N,N-dimethyl-MTA has Dopaminergic Effects and does not Produce Aortic Contraction. Basic Clin Pharmacol Toxicol 2013; 114:395-9. [DOI: 10.1111/bcpt.12168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 10/30/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Ramón Sotomayor-Zárate
- Centro de Neurobiología y Plasticidad Cerebral; Departamento de Fisiología, Facultad de Ciencias; Universidad de Valparaíso; Valparaíso Chile
- Millennium Science Nucleus in Stress and Addiction; Faculty of Biological Sciences; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Pablo Jara
- Faculty of Chemistry and Biology; University of Santiago de Chile; Santiago Chile
| | - Patricio Araos
- Centro Regional de Estudios en Alimentos y Salud (CREAS); Región de Valparaíso Chile
| | - Raúl Vinet
- Centro Regional de Estudios en Alimentos y Salud (CREAS); Región de Valparaíso Chile
- Laboratorio de Farmacología y Bioquímica; Facultad de Farmacia; Universidad de Valparaíso; Valparaíso Chile
| | - Gabriel Quiroz
- Department of Chemistry; Faculty of Sciences; University of Chile; Santiago Chile
| | - Georgina M. Renard
- Centro de Neurobiología y Plasticidad Cerebral; Departamento de Fisiología, Facultad de Ciencias; Universidad de Valparaíso; Valparaíso Chile
| | - Pedro Espinosa
- Centro de Neurobiología y Plasticidad Cerebral; Departamento de Fisiología, Facultad de Ciencias; Universidad de Valparaíso; Valparaíso Chile
| | | | - Pablo R. Moya
- Centro de Neurobiología y Plasticidad Cerebral; Departamento de Fisiología, Facultad de Ciencias; Universidad de Valparaíso; Valparaíso Chile
| | | | - Katia Gysling
- Millennium Science Nucleus in Stress and Addiction; Faculty of Biological Sciences; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Miguel Reyes-Parada
- School of Medicine; Faculty of Medical Sciences; University of Santiago de Chile; Santiago Chile
- Facultad de Ciencias de la Salud; Universidad Autónoma de Chile; Santiago Chile
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