Cerebrovascular function

PMs exhibit a poorer cerebrovascular function, which might affect drug penetration in the brain, with the consequent therapeutic implications. 

MerHni M, Meyer EP, Ulmann-Schuler A et al (2011) Vascular p-amyloid and early astrocyte alterations impair cerebrovascular function and cerebral metabolism in transgenic arcAp mice. Acta Neuropathol 122 293-311... 

Due to the pivotal role of platelets in thrombus formation, especially in the arterial system, inhibition of platelet function has become a central pharmacological approach. Antiplatelet drugs are given in order to prevent and treat thromboembolic diseases such as coronary heart disease, peripheral and cerebrovascular disease. They have also revolutionized the procedures of invasive coronary interventions as they reduce the risk of restenosis and thrombosis. 

The MAOI antidepressant drag s are contraindicated in patients widi known hypersensitivity to die drug s, liver and kidney disease, cerebrovascular disease, hypertension, or congestive heart failure and in die elderly. These drag s are given cautiously to patients witii impaired liver function, history of seizures, parkinsonian symptoms, diabetes, or hyperthyroidism. 

Most cases of AzD show cerebrovascular amyloid deposits and the amyloid protein of senile plaques is the same as that found in blood vessels. It is referred to as )S-amyloid protein and is part of a 695, 751 or 770 amino-acid amyloid precursor protein APP, which is a transmembrane protein and although its precise function is not clear, it is widely distributed and APP knock-out mice show reduced motor function. Normally so-called short 40 amino-acid-soluble derivatives of APP are produced by proteolytic cleavage of APP within the j] (A4) amino-acid sequence but APP can also be cleaved... 

Risk factors for embolic cerebrovascular accidents include previous ischemic stroke, transient ischemic attacks (TIA), systemic embolism, age >75 yr, moderately or severely impaired left ventricular systolic function, hypertension, diabetes mellitus... 

Renal effects - Ketorolac is contraindicated in patients with advanced renal impairment and in patients at risk for renal failure because of volume depletion. Risk of bleeding - Ketorolac inhibits platelet function and, therefore, is contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, and incomplete hemostasis, and in those at high risk of bleeding. 

C. Ginkgo would be the most likely herbal treatment to benefit this patient, since it would improve cerebrovascular blood flow and cognitive function. Vertigo and tinnitus may also respond, although there is more evidence for the former. GarUc is traditionally used for cardiovascular benefits (Upid, blood pressure reduction), but it would be unlikely to produce immediate results. Peppermint is used as an antispasmodic in irritable bowel syndrome, while ginger tea is a common carminative (gas reducer) and motion sickness treatment. Valerian is useful as a sedative. 

It is indicated in spasticity due to neurological disorders e.g., multiple sclerosis, chronic myelopathy, degenerative diseases of the spinal cord, cerebrovascular accidents and cerebral palsy painful muscle spasm associated with static and functional disorders of the spine (cervical and lumbar syndromes) painful muscle spasm following surgery e.g., for herniated intervertebral disc or for osteoarthritis of the hip. 

Dipyridamole is a vasodilator that inhibits platelet function by inhibiting adenosine uptake and cGMP phosphodiesterase activity. Dipyridamole by itself has little or no beneficial effect. Therefore, therapeutic use of this agent is primarily in combination with aspirin to prevent cerebrovascular ischemia. It may also be used in combination with warfarin for primary prophylaxis of thromboemboli in patients with prosthetic heart valves. A combination of dipyridamole complexed with 25 mg of aspirin is now available for secondary prophylaxis of cerebrovascular disease. 

Anticoagulants are used to prevent cardiovascular and cerebrovascular accidents. Most patients who are on anticoagulants are elderly people with chronic heart and vascular diseases. From a TCM perspective, the blood becomes thicker and tends to coagulate when heat (often generated by stress and emotional disturbance) consumes the blood, or when phlegm accumulates as a result of Spleen deficiency. Kidney deficiency is a potential cause of this as the Kidney-Qi weakens with age and is unable to maintain the proper functioning of the Spleen and Liver. 

Topical anesthesia has also been used to improve motor function in some patients with skeletal muscle hypertonicity resulting from a cerebrovascular accident (CVA) or head trauma.53 In this situation, a local anesthetic (e.g., 20% benzocaine) can be sprayed on the skin overlying hypertonic muscles, and then various exercises and facilitation techniques can be performed to increase and improve mobility in the affected limbs. The rationale of this treatment is that it temporarily decreases abnormal or excessive excitatory feedback of cutaneous receptors on efferent motor pathways so that normal integration and control of motor function can be reestablished. Preliminary evidence has suggested that repeated application of this... 

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