Abstracts of the Vth International Symposium on Cerebral Vasospasm
Canadian Journal of Neurological Sciences
The present prospective study, with participation of five of the six neurosurgical centers in Sweden, was conducted to evaluate our overall management results in aneurysmal SAH. Six million nine hundred thirty thousand (6.93) of Swedens 8.59 million inhabitants (81%) were covered by the participating centres . All patients with verified aneurysmal SAH admitted between June 1 1989 and May 31 1990, were prospectively collected. A uniform management protocol was adopted including ultra-early
... al, earliest possible surgery and aggressive anti-ischemic treatment. A total of 325 patients were admitted, 69% within 24 hours after the bleed. Upon admission the patients were graded according to Hunt&Hess: 43 patients (13%) were grade I, 119 (37%) in grade II, 53 (16%) in grade III, 76 (23%) in grade IV and 34 (10%) in grade V. Nimodipine was administered in 269 of the 325 patients. Surgery was performed in 276 (85%) of the patients. Early surgery, ie within 72 hours after the bleed, was performed in 170 individuals. At follow-up 3-6 months after the bleed 183 patients were classified as having made a good neurological recovery (56%) , 73 patients suffered from morbidity (23%) and 69 were dead (21%). In 19 patients (5.8%1 the unfavorable outcome was caused bv delayed cerebral ischemia. However, three other causes had more victims; the initial bleed (65patients, 20%), rebleeding (20, 6.2%) and surgical trauma (20, 6.2%). Furthermore, we will present details concerning the relationship between age, preexisting arterial hypertension, clinical grade on admission, CT-grading according to Fisher, timing of surgery and localisation of the ruptured aneurysm to the occurrence of symptomatic vasospasm. Withdrawn. B CLINICAL STUDIES IN VASOSPASM: ONSET AND PROGRESSION Y.N. Zubkov. R.R. Smith*. A . L . P o l e n o v N e u r o s u r g i c a l I n s t i t u t e , S t . P e t e r s b u r g , R u s s i a ; D e p a r t m e n t of N e u r o s u r g e r y * , U n i v e r s i t y of h i g h e r g r a d e s . O n s e t o c c u r r e d o v e r m i n u t e s o r h o u r s , s o m e t i m e s s i m u l a t i n g r e b l e e d i n g . The s i g n s i n v o l v e d b o t h c o n s c i o u s n e s s and t h e m o t o r s y s t e m s a n d w e r e u s u a l l y p r o f o u n d . I n t r a c r a n i a l p r e s s u r e was u s u a l l y e l e v a t e d s i g n i f i c a n t l y i n t h i s g r o u p b u t d i d n o t r i s e p r e c i p i t o u s l y w i t h t h e e v e n t . The b r a i n s t e m s i g n s a s s o c i a t e d w i t h t h e i n s i d i o u s f o r m , i n o u r o p i n i o n , a r e d i r e c t l y a t t r i b u t a b l e t o i n v o l v e m e n t of s h o r t p e n e t r a t i n g a r t e r i e s . T h i s o b s e r v a t i o n was c o n f i r m e d by xenon b l o o d f l o w s t u d i e s s c i n t i a n g i o g r a p h y . ANGIOGRAPHIC VASOSPASM IN THE NINETIES-A CONTINUING PHENOMENON. T.The past 15 years have seen significant changes in the management of patients with aneurysmal subarachnoid haemorrhage (SAH). Many of these changes, such as management of fluids and blood pressure and the use of calcium channel blockers, have been directed at the prevention and treatment of vasospasm. The angiograms of a contemporary series of 56 consecutive surgically treated patients with aneurysmal SAH were examined to compare the pattern and degree of angiographic spasm with that of previous studies. 37 patients (76%) were WFNS grades 1-2. A ratio of subarachnoid vessel calibre to that of the same vessels extracranially at the skull base was plotted against day of angiogram. This demonstrated that the time course of angiographic spasm remains unchanged from that of previous series, with onset at day 4, maximal spasm during the second week, and resolution after day 16. 30% of patients had clinical vasospasm (delayed neurological deficit for which other causes had been excluded), and these patients had more severe angiographic narrowing than those without clinical spasm, particularly in the second week post SAH (mean ratio value 1.42 v 1.73, p < .05). 44 angiograms were performed between days 1-3 post SAH and repeated between days 4-16. 95% of these showed narrowing at the second angiogram, with an average ratio reduction of 21%. Patients not achieving independence showed a trend towards having had both clinical vasospasm and more severe angiographic vasospasm, although this did not reach statistical significance. We conclude that angiographic spasm remains a common occurrence in the modern era, and continues to be associated with clinical events and poor outcomes.