Anesthetic methods in rats determine outcome after experimental focal cerebral ischemia: mechanical ventilation is required to obtain controlled experimental conditions.

Cerebral vasodilators (second of two parts).

While their importance in the market-place is steadily increasing in developed (mainly continental Europe) and even in developing countries, compounds included in the broad category of 'cerebroactive' drugs hardly rate a mention in reference pharmacology and therapeutics textbooks. It is an undeniable fact, however, that the principal users or targets of this drug class, mainly elderly people, represent an increasingly worrying problem, with their often puzzling cohort of ill-definable and even less predictable neurological and mental symptoms. The combination of the above factors cannot but produce a rather confused situation, in which the pressure to treat and the adherence to scientifically rigorous assessment are likely to prevail alternately, on a purely casual basis. This review aims to provide sound methodological guidelines for assessment of 'cerebroactive' drugs in a not always easily accessible literature. It covers firstly the general problems of stroke, dementia and 'common symptoms' of the elderly, and then looks in detail at those compounds which have to date attracted most attention (ergot derivatives, cinnarizine, flunarizine, vincamine, eburnamonine, naftidrofuryl, oxpentifylline, piracetam and citicoline), as well as those which are currently considered investigational (choline and lecithin). The pharmacology and available clinical studies of each drug are examined. No therapeutic indication can be derived from the available evidence, as the few positive results do not go beyond random improvement of symptoms. More fundamentally, the lines of research which need to be pursued most intensively relate to better preliminary definition of diagnostic and prognostic criteria and, with the establishment of adequate testing tools for the assessment of behaviour and neuropsychological performance, those basal conditions which are modified 'naturally' or by drugs.

/pdf/cerebroactive-drugs-clinical-pharmacology-and-therapeutic-36fba8ryah.pdf

'Cerebroactive' drugs. Clinical pharmacology and therapeutic role in cerebrovascular disorders.

Cerebral vasodilating agents have been questioned as an effective form of therapy for the stroke patient and even have been considered by some to be harmful. Animal studies show that often vasodilating agents will cause an intracerebral steal, but such a reaction has rarely been demonstrated in stroke patients. Several studies measuring cerebral blood flow in man have shown that vasodilating agents will increase cerebral blood flow even in ischemic regions in some patients. Significant clinical studies have not been carried out to determine whether these agents will alter the natural history of the disease. On the basis of reported studies of the effect of vasodilating agents on the cerebral circulation, it is suggested that further laboratory and clinical studies be performed. These agents could potentially be an effective form of therapy in some patients with occlusive cerebrovascular disease.

Cerebral Vasodilator Therapy in Stroke

Hydergine effect on cerebral circulation in cerebrovascular disease.

The development of a method by Lassen and Ingvar [4] to measure regional brain blood flow has added a new dimension to the studies of the cerebral circulation. Lassen, Ingvar and their associates [5], and Glass and Harper [1] first used the isotope clearance method for measurements over the intact skull in man.

Evaluation of the rCBF Method of Lassen and Ingvar

The Cerebral Vascular Response to Hypercapnia in Stroke

Cerebral autoregulation is one of the main factors controlling cerebral circulation. It permits a fluctuation in blood pressure over a wide range without an appreciable change in cerebral blood flow. Recently several studies in animals (1, 2) and in man (3–6) have shown that under certain circumstances cerebral autoregulation may be impaired or lost and that cerebral blood flow will become passively dependent on changes in arterial blood pressure. The purpose of this study was to determine the frequency of the loss or presence of total and regional cerebral autoregulation following induced hypertension.

Cerebral Autoregulation. Regional Cerebral Blood Flow and Cardiohemodynamic Measurements

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Papers

Hydergine effect on cerebral circulation in cerebrovascular disease.

Evaluation of the rCBF Method of Lassen and Ingvar

The Cerebral Vascular Response to Hypercapnia in Stroke

Cerebral Autoregulation. Regional Cerebral Blood Flow and Cardiohemodynamic Measurements