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2 results

  • Chapter 7.1 - Reversible Cerebral Vasoconstriction Syndrome

  • from 7 - Vasospastic Conditions and Other Vasculopathies
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book:
    Rare Causes of Stroke
    Published online:
    06 October 2022
    Print publication:
    01 September 2022, pp 293-298

  • Summary

    RCVS is a clinical radiological syndrome that typically presents with severe headache, with or without other neurological symptoms, and is associated with diffuse multifocal cerebral vasoconstriction that resolves spontaneously within 3 months. Most of the RCVS cases are associated with vasoactive medications, recreational drugs, pregnancy and postpartum state and migraine headaches.It usually begins with an acute, extremely severe thunderclap headache, like a headache in subarachnoid hemorrhage. Epileptic seizures have been reported and focal neurological deficit may present as a TIA or with visual disturbances. In more than 90% of patients, complete withdrawal of symptoms occur, but RCVS may be complicated with cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, or posterior reversible encephalopathy syndrome.Rarely, these complications lead to death. Catheter angiography, MR angiography or CT angiography may disclose a “string-of-beads” and “sausage and strings” appearance of vessels. In the treatment of cerebral vasospasm, the use of calcium channel blockers for about 4-8 weeks may be considered

  • Chapter 18 - Principles of antibiotics use

  • from Section II: - Systemic disorders and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 124-129

  • Summary

    The failure of cardiovascular system to maintain adequate organ perfusion pressure causes inadequate oxygen delivery resulting in tissue hypoxia, lactic acidosis and end organ damage. Inotropes affect the force of myocardial contraction. A positive inotrope will increase myocardial contractility. Vasopressors cause vasoconstriction of blood vessels (most act by α1 receptor activation) and therefore increase mean arterial blood pressure (MAP) and systemic vascular resistance (SVR). Vasoactive drugs are used to support tissue perfusion and hence oxygenation. Vasoactive drugs act on various receptors in the body to produce their effects. Treatment with vasoactive drugs should be considered, if optimization of oxygenation, ventilation and adequate fluid resuscitation fail to restore cardiac output. Therapy may need to be started with minute-by-minute assessment of the patient's response. The response to vasoactive drugs is often unpredictable and dependent on the cause of shock and baseline circulation.