Treatment may reduce post-stroke damage.

Treatment may reduce post-stroke damage

A ballooning weak spot on an artery wall bursts suddenly, spilling blood into the fluid surrounding the brain. This catastrophic event, a form of stroke called subarachnoid hemorrhage, strikes an estimated 35,000 people in the United States each year.

Physicians treating people who survive the initial vessel blowout face a grim dilemma. On the one hand, early surgery to clip or repair the vessel wall can lower the patient's chance of a second deadly bleed should the weak spot burst again. But some researchers have suggested that people recovering from such surgery run an increased risk of another setback: Intact arteries supplying blood to the brain may constrict, robbing brain cells of blood and threatening neurological problems such as paralysis, speech difficulty or permanent brain damage.

On the other hand, delaying surgery until vessel constriction subsides exposes the patient to the threat of a second, potentially fatal artery rupture.

In a preliminary study, British researchers have now found that an experimental drug -- calcitonin-gene-related peptide -- temporarily reversed symptoms caused by reduced blood flow to the brain in people recovering from surgery for a ruptured artery. If larger studies confirm these results, the treatment might make early surgery safer for people who have suffered subarachnoid hemorrhage, suggest F.G. Johnston of the Atkinson Morley's Hospital in London and colleagues in the April 14 LANCET.

Johnston's group studied 15 patients who had just undergone early surgery for subarachnoid hemorrhage and who showed neurological symptoms indicating reduced blood flow to the brain. They gave each patient one infusion of calcitonin-gene-related peptide and one infusion of a placebo solution, in random order, 24 hours apart. Nine of the 15 showed improvement after receiving the drug, while only two of the 15 improved after placebo shots, the researchers report. These results suggest the peptide can reverse ongoing vessel spasm, they say.

The symptomatic improvement noted by the British researchers lasted only 15 to 50 minutes after the drug infusion ended. Scientists still don't know whether continuous infusion during the risky posturgical period -- perhaps for as long as two weeks -- would prevent neurological damage over the long run. Vessel spasms in patients recovering from surgery usually persist for a limited period and then subside, Johnston told SCIENCE NEWS.

Neal F. Kassell, a neurosurgeon at the University of Virginia School of Medicine in Charlottesville, calls calcitonin-gene-related peptide a "potential new treatment for vasospasm." However, he and neurologist Harold P. Adams Jr. emphasize the preliminary nature of the new report. "Fifteen patients is far from a conclusive study," says Adams, of the University of Iowa College of Medicine in Iowa City. "What is needed now is a much more extensive experience with this therapy to learn where it fits in with the management of patients with subarachnoid hemorrhage."