Part 1: Ischemic Stroke: Pathophysiology and Principles of Localization

Matthew Brandon Maas, MD, and Joseph E. Safdieh, MD

Dr. Maas is a fellow in Stroke and Neurocritical Care, Harvard Medical School, Departments of Neurology, Massachusetts General and Brigham and Women’s Hospitals, Boston, MA. Dr. Safdieh is an assistant professor of neurology, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY.

Question 1

Vasospasm and ischemic stroke are frequent complications of aneurysmal subarachnoid hemorrhage (SAH). Nimodipine, a calcium channel antagonist, has been shown to improve outcomes when administered soon after diagnosis of SAH. What is the most likely mechanism?

  •  Prevention of segmental arterial vasospasm by relaxing arterial smooth muscle
  •  Reduced severity of SAH-associated myocardial shock by diminishing cardiac
    afterload
  •  Reduction of pathologic calcium influx in ischemic cells, inhibiting apoptosis
  •  Vasodilation of the cerebral vasculature facilitating passive perfusion

Updated 12/03/2014 • jdw | Copyright ©2014 Turner White Communications