Nitric oxide inhalation reduces brain damage, prevents mortality, and improves neurological outcome after subarachnoid hemorrhage by resolving early pial microvasospasms.

Terpolilli, Nicole A; Feiler, Sergej; Dienel, Ari; Müller, Frank; Heumos, Nicole; Friedrich, Benjamin; Stover, John; Thal, Serge; Schöller, Karsten; Plesnila, Nikolaus (2015). Nitric oxide inhalation reduces brain damage, prevents mortality, and improves neurological outcome after subarachnoid hemorrhage by resolving early pial microvasospasms. Journal of cerebral blood flow and metabolism, 36(12), 0271678X15605848. Nature Publishing Group 10.1177/0271678X15605848

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Subarachnoid hemorrhage is a stroke subtype with particularly bad outcome. Recent findings suggest that constrictions of pial arterioles occurring early after hemorrhage may be responsible for cerebral ischemia and - subsequently - unfavorable outcome after subarachnoid hemorrhage. Since we recently hypothesized that the lack of nitric oxide may cause post-hemorrhagic microvasospasms, our aim was to investigate whether inhaled nitric oxide, a treatment paradigm selectively delivering nitric oxide to ischemic microvessels, is able to dilate post-hemorrhagic microvasospasms; thereby improving outcome after experimental subarachnoid hemorrhage. C57BL/6 mice were subjected to experimental SAH. Three hours after subarachnoid hemorrhage pial artery spasms were quantified by intravital microscopy, then mice received inhaled nitric oxide or vehicle. For induction of large artery spasms mice received an intracisternal injection of autologous blood. Inhaled nitric oxide significantly reduced number and severity of subarachnoid hemorrhage-induced post-hemorrhage microvasospasms while only having limited effect on large artery spasms. This resulted in less brain-edema-formation, less hippocampal neuronal loss, lack of mortality, and significantly improved neurological outcome after subarachnoid hemorrhage. This suggests that spasms of pial arterioles play a major role for the outcome after subarachnoid hemorrhage and that lack of nitric oxide is an important mechanism of post-hemorrhagic microvascular dysfunction. Reversing microvascular dysfunction by inhaled nitric oxide might be a promising treatment strategy for subarachnoid hemorrhage.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Feiler, Sergej

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0271-678X

Publisher:

Nature Publishing Group

Language:

English

Submitter:

Nicole Söll

Date Deposited:

12 Apr 2016 14:47

Last Modified:

15 Jan 2017 02:06

Publisher DOI:

10.1177/0271678X15605848

PubMed ID:

26661144

Uncontrolled Keywords:

Cerebral perfusion; early brain injury; microvasospasm; nitric oxide; subarachnoid hemorrhage

URI:

https://boris.unibe.ch/id/eprint/80151

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