Importância da Hemorreologia clínica no estudo do fluxo sanguíneo cerebral em condições normais e na isquemia Cerebrovascular

Melaragno Filho, Roberto

doi:10.1590/S0004-282X1995000100025

Resumos

É apresentada avaliação crítica da importância da hemorreologia no estabelecimento da conduta terapêutica clínica na insuficiência cerebrovascular aguda. Com essa finalidade são revistos aspectos relativos a fluxo sanguíneo cerebral, insuficiência cerebrovascular e hemorreologia clínica. Em função desses aspectos são avaliados alguns dos principais medicamentos utilizados no presente no tratamento do acidente vascular cerebral e são discutidas normas gerais para prevenção e tratamento das isquemias cerebrais.

hemorreologia clínica; acidente cerebrovascular; tratamento; prevenção

A critical review on the importance of hemorrheology for establishing clinical management of acute cerebrovascular insufficiency is presented. With this purpose a revision is made on cerebral blood flow, acute cerebrovascular insufficiency, and clinical hemorrheology. Data support an evaluation on main drugs presently used in the management of stroke, and on general principles adopted for medical treatment and prevention of stroke.

clinical hemorrheology; stroke; treatment; prevention

Importância da Hemorreologia clínica no estudo do fluxo sanguíneo cerebral em condições normais e na isquemia Cerebrovascular

The importance of clinical Hemorrheology for studying the cerebral blood flow in normal conditions and in Cerebrovascular ischemia

Roberto Melaragno Filho

Organizador e Ex-Diretor do Serviço de Neurologia do Hospital do Servidor Público Estadual de São Paulo; livre-Docente da Cínica Neurológica da Faculdade de Medicina da Universidade de São Paulo

RESUMO

É apresentada avaliação crítica da importância da hemorreologia no estabelecimento da conduta terapêutica clínica na insuficiência cerebrovascular aguda. Com essa finalidade são revistos aspectos relativos a fluxo sanguíneo cerebral, insuficiência cerebrovascular e hemorreologia clínica. Em função desses aspectos são avaliados alguns dos principais medicamentos utilizados no presente no tratamento do acidente vascular cerebral e são discutidas normas gerais para prevenção e tratamento das isquemias cerebrais.

Palavras-chave: hemorreologia clínica, acidente cerebrovascular, tratamento, prevenção.

SUMMARY

A critical review on the importance of hemorrheology for establishing clinical management of acute cerebrovascular insufficiency is presented. With this purpose a revision is made on cerebral blood flow, acute cerebrovascular insufficiency, and clinical hemorrheology. Data support an evaluation on main drugs presently used in the management of stroke, and on general principles adopted for medical treatment and prevention of stroke.

Key words:clinical hemorrheology, stroke, treatment, prevention.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 20-dezembro-1994.

Dr. Roberto Melaragno Filho - Rua Professor Arthur Ramos 96, 10º andar - 01454-010 São Paulo SP - Brasil.

1. Albens GM, Goldberg MP, Choi DW. N-methyl-D-aspartate antagonists: ready for clinical trial in brain ischemia. Ann Neurol 1989, 25:398-403.
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3. Auer RN. Calcium channel antagonists. In Cerebral ischemia: a review in drugs in development Vol 2 (CA 2+ antagonists in CNS). Branford: New Press, 1993.
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5. Bada HS, Korones SB, Pourcyrous M, Wong SP, Wilson WM, Ford, DL. Asymptomatic syndrome of polycythemic hyperviscosity: effect of partial exchange transfusion. J Pediat 1992, 579:385.
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7. Black RS, Barclay LL, Nolan KA, Thaler HT, Hardiman ST, Blass JB. Pentoxifylline in cerebrovascular dementia. J Am Geriat Soc 1992, 40:237-244.
8. Blume J, Riihlmann KV, De la Haye R, Rettiy K Treatment of chronic cerebrovascular disease in elderly patients with pentoxifylline. J Med 1992, 32:417-431.
9. Bowton DL, Stump DA, Prough DS, Toole JF, Lefkowitz DS, Coker L. Pentoxifylline increases cerebral blood flow in patients with cerebrovascular disease. Stroke 1989, 20:1662-1666.
10. Brass LM, Prohovnik I, Pavlakis SG, De Vivo DC, Pionelli S, Mohr JP. Middle cerebral artery blood velocity and cerebral blood flow in sickle cell disease. Stroke 1991, 22:27-30.
10a.Brott T. Thrombolytic therapy for stroke. Cerebrovasc Brain Metab Rev 1991, 3:91-113.
11. Cavestü R, Radice L, Ferrarini F, Longhini M, Longhini E. Influence of erythrocyte aggregability and plasma fibrinogen concentration on CBF with aging. Acta Neurol Scand 1992, 85:292-298.
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14. Cohen M, Toledo Morrell L, Morrei F. Tratamiento farmacologico de la demência multi-enfarte. In Chopra J et al. Progress in cerebrovascular disease. Amsterdam: Elsevier, 1990, p 83-90.
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16. Deleo J, Toth L, Schubert P, Rudolphi K, Kreutzerg GM. Ischemia induced neuronal cell-death, calcium accumulation, and glial response.in the hippocampus of the mongolian gerbil and protection by propentofylline (HWA 285). J Cer Blood Flow Metab 1987, 7:745-751.
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20b.Fitt GJ, Farrar J, Baird AE, Brooks M, Gilligan A, Donnan GA, Henessy O. Intra-arterial streptokinase in acute ischaemic stroke: a pilot study. Med J Austr 1993, 159:331-333.
20c.Fagan SC, Zarowitz BJ, Robert S. "Brain attack": an indication for thrombolysis. Ann Pharmacother 1992, 26:73-79.
21. Ghose K. Oxpentofylline in dementia: a controlled study. Arch Gerontol Geriat 1987, 6:19-26.
22. Grome JJ, Rudolphi K, Harper AM. Cerebrovascular effects of a xanthine derivative propentofylline (HWA 285). Drug Develop Res 1985, 5:111-121.
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35. Hsu CY. Possible complications of pentoxifylline in stroke. Stroke 1989, 20:1115.
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Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Mar 1995

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[1] 1. Albens GM, Goldberg MP, Choi DW. N-methyl-D-aspartate antagonists: ready for clinical trial in brain ischemia. Ann Neurol 1989, 25:398-403.

[2] 2. Andinér A, Rudolphi KA, Fredholm BB, Hagberg H. Effect of propentofylline (HWA 285) on extra-cellular apurines and excitatory amino acids in CA1 of rat hippocampus during transient ischemia. J Pharmacol 1990, 100:814-819.

[3] 3. Auer RN. Calcium channel antagonists. In Cerebral ischemia: a review in drugs in development Vol 2 (CA 2+ antagonists in CNS). Branford: New Press, 1993.

[4] 4. Awad IA, Carter LP, Spetzler RF, Medina M,Williams FW Jr. Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 1982, 18:365-372.

[5] 5. Bada HS, Korones SB, Pourcyrous M, Wong SP, Wilson WM, Ford, DL. Asymptomatic syndrome of polycythemic hyperviscosity: effect of partial exchange transfusion. J Pediat 1992, 579:385.

[6] 6. Baird AE, Donnan GA, Austin MC, Fitt GJ, Davis SM, McKay WJ. Reperfusion after thrombolytic therapy in ischemic stroke measured by single-photon emission computed tomography. Stroke 1994, 25: 79-85.

[7] 7. Black RS, Barclay LL, Nolan KA, Thaler HT, Hardiman ST, Blass JB. Pentoxifylline in cerebrovascular dementia. J Am Geriat Soc 1992, 40:237-244.

[8] 8. Blume J, Riihlmann KV, De la Haye R, Rettiy K Treatment of chronic cerebrovascular disease in elderly patients with pentoxifylline. J Med 1992, 32:417-431.

[9] 9. Bowton DL, Stump DA, Prough DS, Toole JF, Lefkowitz DS, Coker L. Pentoxifylline increases cerebral blood flow in patients with cerebrovascular disease. Stroke 1989, 20:1662-1666.

[10] 10. Brass LM, Prohovnik I, Pavlakis SG, De Vivo DC, Pionelli S, Mohr JP. Middle cerebral artery blood velocity and cerebral blood flow in sickle cell disease. Stroke 1991, 22:27-30.

[11] 10a.Brott T. Thrombolytic therapy for stroke. Cerebrovasc Brain Metab Rev 1991, 3:91-113.

[12] 11. Cavestü R, Radice L, Ferrarini F, Longhini M, Longhini E. Influence of erythrocyte aggregability and plasma fibrinogen concentration on CBF with aging. Acta Neurol Scand 1992, 85:292-298.

[13] 12. Chien Shu. What is clinical haemorrheology ? In Gotoh F, Lecher H (eds). Clinical hemorrheology: new approach to cerebrovascular disease. London: R Soc Med Internat Congr Symp Series, 1986.

[14] 13. Choi, DW Bench to bedside: the glutamate connection. Science 1992, 258:241-243.

[15] 14. Cohen M, Toledo Morrell L, Morrei F. Tratamiento farmacologico de la demência multi-enfarte. In Chopra J et al. Progress in cerebrovascular disease. Amsterdam: Elsevier, 1990, p 83-90.

[16] 15. Coull BC, Beamer N, de Garmo P, Sexton G, Nordt F, Knox R, Seaman GVF. Chronic blood hyperviscosity in subjects with acute stroke, transient ischemic attack, and risk factors for stroke. Stroke 1991, 22:162-168.

[17] 16. Deleo J, Toth L, Schubert P, Rudolphi K, Kreutzerg GM. Ischemia induced neuronal cell-death, calcium accumulation, and glial response.in the hippocampus of the mongolian gerbil and protection by propentofylline (HWA 285). J Cer Blood Flow Metab 1987, 7:745-751.

[18] 17. Deleo J, Schubert P, Kreutzberg GW. Protection against brain damage using propentofylline in gerbils. Stroke 1988, 19:1535-1539.

[19] 18. Dominguez D. Vascular dementia and neuropsychological disorders of the ageing brain. In Gotoh F, Lechner H (eds). Clinical hemorreology: new approach to cerebrovascular disease. London: R Soc Med Ingernat Congr Symp Series, 1986.

[20] 19. Dragunow M. Possible complicaltions of pentoxiphylline in stroke. Stroke 1989, 20:1115.

[21] 20. Elwan D, Ashmawy S, El-Karasky S, Hassan AA. Hemorrheology, stroke and the elderly. J Neurol 1991, 101:157-162.

[22] 20a. Ernst E, Matrai A Paulsen F. Leukocyte rheology in recent stroke. Stroke 987,18:59-62.

[23] 20b.Fitt GJ, Farrar J, Baird AE, Brooks M, Gilligan A, Donnan GA, Henessy O. Intra-arterial streptokinase in acute ischaemic stroke: a pilot study. Med J Austr 1993, 159:331-333.

[24] 20c.Fagan SC, Zarowitz BJ, Robert S. "Brain attack": an indication for thrombolysis. Ann Pharmacother 1992, 26:73-79.

[25] 21. Ghose K. Oxpentofylline in dementia: a controlled study. Arch Gerontol Geriat 1987, 6:19-26.

[26] 22. Grome JJ, Rudolphi K, Harper AM. Cerebrovascular effects of a xanthine derivative propentofylline (HWA 285). Drug Develop Res 1985, 5:111-121.

[27] 23. Grotta J, Ackerman R, Correia J, Fallick G, Chang J. Whole blood viscosity parameters and cerebral blood flow. Stroke 1982, 13:296-301.

[28] 24. Grotta JC.Current status of hemodilution in acute cerebral ischemia (Edit). Stroke 1987, 18:689-690.

[29] 25. Hamilton MG, Lee JS, Cummings P. A comparison of intra-arterial and intravenous tissue-type plasminogen activator on autologous arterial emboli in the cerebral circulation of rabitts. Stroke 1994, 25: 651-656.

[30] 26. Harwart D. The treatment of chronic cerebrovascular insufficiency: a double blind study with pentoxifylline (Trental 400). Curr Med Res Opin 1979, 6:73-84.

[31] 27. Hartmann A. Hemorrheological treatment of acute cerebral ischemia. In Gotoh F, Lechner H (eds). Clinical hemorrheology: new approach to cerebrovascular disease. London: R Soc Med Internat Congr Symp Series, 1986.

[32] 28. Hartmann A, Lagreze H, Broich K, Fric M. Treatment of acute ischemia by colloid solutions. In Chopra J et al (eds). Progress in cerebrovascular disease. Amsterdam: Elsevier, 1990.

[33] 29. Hartmann A, Tsuda Y. A controlled study on the effect of pentoxifylline and an ergot alcaloid derivative on regional cerebral blood flow in patients with chronic cerebrovascular disease. Angiology 1988, 39:449-457.

[34] 30. Hemodilution in Stroke Study Group. Hypervolemic hemodilution treatment of acute stroke: results of randomized trials using pentastarch in focal cerebral ischemia. Stroke 1989, 20:543-540.

[35] 31. Herskovits E, Famulari A, Tamaroff L, Gonzalez A; Vasquez A Dominguez D. Preventive treatment of cerebral transient ischemia: comparative trial pentoxifylline versus conventional antiaggregants. Neurology 1948, 24:73-81.

[36] 32. Hino A, Ueda S, Mizukawa N, Imahori YH. Effect of hemodilution on cerebral hemodynamics and oxygen metabolism. Stroke 1992, 23:423-426.

[37] 33. Hossman V, Heiss WD, Berwermeyer H, Wiedemann G. Controlled trial of ancrod in ischemic stroke. Arch Neurol 1983, 40:803.

[38] 34. Hsu C, Norris JW, Hogan EL, Bladin P, Dinsdale HB, Yatsu FM, Earnest MP, Sheinberg P Caplan LR, Swanson PD, Feldman RG, Cohen MM, Mayman CI, Gobert B, Savitsky JB (Pentoxifylline Study Group). Pentoxifylline in acute nonhemorrhagic stroke: a randomized placebo controlled double blind study. Stroke 1988, 19:716-722.

[39] 35. Hsu CY. Possible complications of pentoxifylline in stroke. Stroke 1989, 20:1115.

[40] 36. Huber M, Kittner B, Hojer C, Fink GR, Neveling M, Heiss WS. Effect of propentofylline on regional cerebral glucose metabolism in acute ischemic stroke. J Cer Blood Flow Metab 1993,13:526-530.

[41] 37. Italian Acute Stroke Study. The Italian Hemodilution Group trial in acute stroke. Stroke 1987, 8:670-676.

[42] 38. Kannel WB, Gordon T; Wolf PA, McNamara P. Hemoglobin and the risk of cerebral infarction in the Framingham Study. Stroke 1972, 3:409-420.

[43] 39. Kee D Jr, Wood JH. Blood viscosity and cerebral blood flow. In Plum F, Pulsinelli A (eds). Vascular diseases: Princeton conference. New York: Raven Press, 1993.

[44] 40. Kilpatrick TJ, Matkovic Z, Davis SM, McGrath CM, Dawer RJ. Hematologic abnormalities occur in both cortical and lacunar infarction. Stroke 1993, 24:1945-1950.

[45] 41. Korusue K, Heros RC. Mechanism of cerebral blood augmentation by hemodilution in rabbits. Stroke 1992, 23:1487-1492.

[46] 42. La Rue L, Alter M, Lai SM, Friday G, Sobel, I; Levitt L, McCoy R, Isack T. Acute stroke, hematocrit, and blood pressure. Stroke 1987, 18:565-569.

[47] 43. Lechner H, Niederkorn K, Schmidt R. Does cerebrovascular insufficiency contribute to Alzheimer's disease? Ann NY Acad Sci 1991, 640.

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