What Is a Vasospasm?

Vasospasm is due to the strong contraction of smooth muscle in the blood vessel wall and narrowing of the lumen, resulting in reduced blood flow. In severe cases, the lumen can be completely occluded. Spasticity for too long can cause vascular embolism. There are two types of neurogenic and myogenic. There are many causes of vasospasm. Common factors are systemic factors such as excessive mental stress, painful stimulation, insufficient blood volume, hypotension, inflammation, or incorrect use of vasoconstrictors, and local factors such as cold, mechanical stimulation, Local vasospasm can be induced by surgical stimulation, dryness, and extravascular contact with fresh blood. ^[1]

Vasospasm

Vasospasm is due to the strong contraction of smooth muscle in the blood vessel wall and narrowing of the lumen, resulting in reduced blood flow. In severe cases, the lumen can be completely occluded. Spasticity for too long can cause vascular embolism. There are two types of neurogenic and myogenic. There are many causes of vasospasm. Common factors are systemic factors such as excessive mental stress, painful stimulation, insufficient blood volume, hypotension, inflammation, or incorrect use of vasoconstrictors. There are also local factors such as cold, mechanical stimulation, Local vasospasm can be induced by surgical stimulation, dryness, and extravascular contact with fresh blood. ^[1]

Arteriosclerotic plaques in the internal carotid artery or vertebral-basal artery system narrow the vessel lumen and vortex flow. When the eddy current accelerates, it stimulates the blood vessel wall and causes vasospasm.

Need to be distinguished from:

1. Focal epilepsy The performance of various types of focal seizures is similar to that of TIA, such as epileptic seizures or motor seizures are easily confused with TIA. Tension-free seizures are similar to sudden attacks. It is better to perform 24-hour EEG Holter monitoring. If there is a focal epilepsy discharge, it can be diagnosed as epilepsy. If there is no abnormality, consider the possibility of TIA. CT or MRI examination found focal non-infarct lesions in the brain, which can also be considered as epilepsy.

two,

First, the cause of treatment

Find out the cause and carry out active treatment, especially the prevention and treatment of atherosclerosis.

Drug treatment

1. Early use of cerebral vasodilators and volume expanders can significantly reduce and terminate clinical episodes of TIA. Can choose to use 20mg betaine and 5% glucose 500ml, or low-molecular dextran or 500ml intravenous infusion. Wei Nao Lu Tong, Sibiling, etc. may also have a certain effect.

2. Antiplatelet aggregation agents reduce the occurrence of microemboli. If there is no ulcer or hemorrhagic disease, aspirin is usually used for treatment ranging from 50mg to 300mg per day. Most people think that a smaller dose is appropriate, and the dose can be reduced if taken for a long time. Persantin (25mg 3 times a day) in combination with aspirin can play a synergistic effect, and can reduce the dose of aspirin. If the patient should not take aspirin or take aspirin with unsatisfactory results, he can switch to Ticlopidine (200--250mg 1--2 times a day) or ticlid 250mg (1 time a day). Attention should be paid to strengthening the prevention and treatment of toxic and side effects such as bleeding.

3 Anticoagulation therapy is frequent for those with frequent attacks, serious illness and progressive aggravation, and there is no obvious contraindication to anticoagulation therapy. Early anticoagulation therapy has positive significance for reducing the incidence of attacks and preventing cerebral infarction. Heparin 12500U is usually added to 5% dextrose physiological saline slowly and intravenously. At the same time, the first day can be taken 300mg neo-coumarin or 100-200mg dicoumarin or 4--6mg warfarin. Check the prothrombin time and activity every day and measure it once a week after stabilization to adjust the oral dose. It is required to maintain the venous coagulation time at 20--30 minutes and the prothrombin activity at 15--25%. The subsequent maintenance amount is 150-225 mg of neo-coumarin, 25-75 mg of dicoumarin or 2--4 mg of warfarin. Attention should be paid to the prevention and treatment of bleeding complications during treatment. Withdrawal should be gradually reduced to avoid "bounce back". Because this treatment is difficult to control the dose and bleeding complications, it is rarely used in China.

4 Calcium antagonists can selectively act on calcium channels of cerebral vascular smooth muscle, prevent calcium ions from flowing into cells from outside the cell, and have the effects of preventing cerebral arterial spasm, dilating blood vessels, increasing cerebral blood flow and maintaining red blood cell deformation. Generally, 5--10 mg sibilin is used once a day.

5. Other traditional Chinese medicines such as extracorporeal anti-blog, ultraviolet light quantum therapy, and blood dilution methods, as well as traditional Chinese medicines such as Chuanxiong and Danshen, can be used to activate blood circulation and clear blood stasis.

Third, surgical treatment

It is confirmed by angiography that there is obvious narrowing or occlusive disease of the aorta of the neck, and the curative effect of the drug is poor. Patients are generally allowed, and those with conditions can consider internal carotid endarterectomy, stent placement or intracranial extracranial anastomosis. It has certain effects on eliminating microembolism, improving cerebral blood flow and establishing collateral circulation. Because it is not a radical method, and the indications and effects of surgery have not yet been confirmed, it is still rarely used in China