The influence of ethanol on blood flow velocity in major cerebral vessels. A prospective and controlled study

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Cerebral vasospasm secondary to subarachnoid hemorrhage leads to increased cerebrovascular resistance and may cause ischemia in the
affected vascular territories. The currently available therapeutic options for treating vasospasm are limited. The effect of ethanol at
a concentration of 0.75 g/kg body weight on blood flow velocity in the major cerebral arteries was studied. In 31 healthy persons, the major
extra- and intracranial cerebral vessels were examined by Doppler ultrasonography before and following oral ingestion of 0.75 g/kg body
weight of ethanol. An additional 20 healthy subjects served as a control group. Ethanol in the applied concentration significantly increased
the systolic, diastolic, and mean blood flow velocities and significantly decreased the pulsatility indices in the middle cerebral artery
(MCA). It may reduce vascular resistance and may increase cerebral blood flow in the area supplied by the MCA in healthy persons.
2006 Elsevier Inc. All rights reserved.

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The influence of ethanol on blood flow velocity in major cerebral vessels.
A prospective and controlled study
Ruediger Stendela,*, Burkhard Irnicha, Ali Abo al Hassana,
Jens Heidenreichb, Terttu Pietilaea
aDepartment of Neurosurgery, Charite´ e Universita¨tsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
bDepartment of Radiology, Charite´ e Universita¨tsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
Received 12 April 2006; received in revised form 11 June 2006; accepted 13 June 2006
Abstract
Cerebral vasospasm secondary to subarachnoid hemorrhage leads to increased cerebrovascular resistance and may cause ischemia in the
affected vascular territories. The currently available therapeutic options for treating vasospasm are limited. The effect of ethanol at
a concentration of 0.75 g/kg body weight on blood flow velocity in the major cerebral arteries was studied. In 31 healthy persons, the major
extra- and intracranial cerebral vessels were examined by Doppler ultrasonography before and following oral ingestion of 0.75 g/kg body
weight of ethanol. An additional 20 healthy subjects served as a control group. Ethanol in the applied concentration significantly increased
the systolic, diastolic, and mean blood flow velocities and significantly decreased the pulsatility indices in the middle cerebral artery
(MCA). It may reduce vascular resistance and may increase cerebral blood flow in the area supplied by the MCA in healthy persons.
2006 Elsevier Inc. All rights reserved.
Keywords: Ethanol; Alcohol; Transcranial Doppler ultrasonography; Cerebrovascular resistance; Pulsatility index
1. Introduction
Cerebral vasospasm (VS) secondary to subarachnoid
hemorrhage (SAH) leads to increased cerebrovascular resistance
(CVR) and may cause ischemia in the affected vascular
territories (Giller et al., 1990; Laumer et al., 1993) with
consecutive permanent disability or death in 13.5% of patients
(Kassell et al., 1990). The currently available therapeutic
options for treating VS are limited (Biondi et al.,
2006; Kassell et al., 1990; Keller et al., 2005; Kosty,
2005; Liu & Couldwell, 2005; Loch Macdonald, 2006;
Wijdicks et al., 2005).
Nimodipine is a calcium antagonist of the 1,4-dihydropyridine
group. It is used to prevent and treat VS and consecutive
delayed ischemic neurological deficits (DINDs) in
patients with SAH (Biondi et al., 2006; Kosty, 2005; Loch
Macdonald, 2006; Rinkel et al., 2002; Wijdicks et al.,
2005). The effectiveness of nimodipine after intravenous
(Gilsbach et al., 1990; O¨ hman & Heiskanen, 1988) and oral
administration (Petruk et al., 1988; Pickard et al., 1989) has
been investigated in prospective studies. Interestingly, intravenous
nimodipine has been found to be more effective
than that of the oral preparation in terms of preventing severe
VS and DIND (Auer, 1984; Gilsbach et al., 1990;
Ljunggren et al., 1984;O¨ hman & Heiskanen, 1988). The intravenous
preparation of nimodipine contains 10 g of 96%
ethanol, corresponding to 28.3% by volume (Bayer-AG,
2005). Hence, it has been postulated that the difference in
effectiveness between the oral and intravenous nimodipine
preparations may be related to the ethanol content. In animal
experiments, nimodipine with and without the ethanol
solvent was topically applied to the cerebral vessels of cats,
and vessel widths were measured using a videoangiometer.
In these experiments, nimodipine plus the ethanol-based
solvent was found to have a stronger vasodilating effect
than that of nimodipine alone (Auer & Mokry, 1986).
There is contradictory data on the effects of ethanol on
the vascular system. While it is undisputed that high blood
alcohol concentrations (BACs) of over 2&lead to vasoconstriction
(Altura & Altura, 1987; Gordon et al., 1995; Hemmingsen
et al., 1979; Mayhan & Didion, 1995), lower
BACs have been found to have no (Mayhan & Didion,
1995) vasoconstricting (Gordon et al., 1995) or vasodilating
(Altura & Altura, 1987; Tiihonen et al., 1994) activity. In
addition, there are reports indicating that administration
* Corresponding author. Tel.: þ49-30-8445-3184; fax: þ49-30-8445-
4610.
E-mail address: ruediger.stendel@charite.de (R. Stendel).
0741-8329/06/$ e see front matter 2006 Elsevier Inc. All rights reserved.
doi: 10.1016/j.alcohol.2006.06.005
Alcohol 38 (2006) 139e146

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