Acute vasoactive effects of estradiol on cerebral vasospasm in women with subarachnoid hemorrhage PDF
Preview Acute vasoactive effects of estradiol on cerebral vasospasm in women with subarachnoid hemorrhage
YALE MEDICAL LIBRARY 3 9002 08676 0858 YALE UNIVERSITY CUSHING/WHITNEY MEDICAL LIBRARY Permission to photocopy or microfilm processing of this thesis for the purpose of individual scholarly consultation or reference is hereby granted by the author. This permission is not to be interpreted as affecting publication of this work or otherwise placing it in the public domain, and the author reserves all rights of ownership guaranteed under common law protection of unpublished | manuscripts. Date Digitized by the Internet Archive in 2017 with funding from Arcadia Fund https://archive.org/details/acutevasoactiveeOOrose ACUTE VASOACTIVE EFFECTS OF ESTRADIOL ON CEREBRAL VASOSPASM IN WOMEN WITH SUBARACHNOID HEMORRHAGE. +Joshua M. Rosenow, #Fhillip M. Sarrel, +Issam A. Awad, ^Lawrence M. Brass. +Section of Neurosurgery, Department of Surgery, and Departments of ^Neurology and ^Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT. Approximately a third of patients diagnosed with subarachnoid hemorrhage will develop symptomatic vasospasm leading to delayed ischemic deficits (DID). Estrogen has been shown to either vasodilate or inhibit vasoconstriction in several vascular beds. This may occur by either a calcium channel-blocking effect or via induction of nitric oxide release by vascular endothelium. We studied 9 women diagnosed with aneurysmal subarachnoid hemorrhage. Estradiol-176 (E2) and progesterone levels were measured daily. Women received daily monitoring for vasospasm with transcranial Doppler (TCD) ultrasound. Patients whose mean blood flow velocities (BFV) exceeded 120 cm/sec were deemed to be in vasospasm and received E2 lmg SL (Estrace®). TCD monitoring was conducted for 20min prior to E2 administration and for 120 min post-administration. E2 levels were measured prior to and 2 hours after administration of E2. Three women were given estradiol a total of 4 times early in their hospitalization. Mean BFV showed a statistically significant decrease from baseline beginning at 25 min (p<.02) and continuing through the 120 min monitoring period (P<.005 at 120min). Mean BFV were not significantly decreased in those trials conducted greater than 6 days post-hemorrhage (n=2). There was no significant change in either peak flow velocity or pulsatility index. This preliminary study demonstrates that estradiol-176 administration leads to a significant decrease in the mean BFV of women who have suffered a SAH. The effect of E2 is greater and begins sooner when it is given prior to 6 days post-hemorrhage. These early data warrant the further investigation of this finding, including double-blind studies to determine the efficacy of E2 supplementation in preventing vasospasm. . Acute Vasoactive Effects of Estradiol on Cerebral Vasospasm in Women with Subarachnoid Hemorrhage A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine ty Joshua Michael Rosenow 1996 YAIE MEVRSI TORY AUG 1 4 1996 ~W> -v\a
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