[Hemorrhagic infarction following cerebral vasospasm].
Among 528 cases with ruptured aneurysm, 10 cases (1.9%) developed hemorrhagic infarction following vasospasm. There was no obvious relationship between the occurrence and location of aneurysm and the neurological grade on admission. Hemorrhagic infarction occurred from day 9 to 25 (mean day 16) after aneurysmal rupture, and the major neurological symptoms were aggravation of consciousness level, which appeared in 6 cases. On the CT scans of the hemorrhagic infarction following vasospasm, nine cases revealed heterogeneous hemorrhage as assembled of spotty or linear hemorrhages within the ischemic infarction, and 5 cases had massive hemorrhagic infarction in size with mass effect. Although surgical therapy for 2 cases and conservative therapy for 8 cases were performed, the results were unfavorable; ie, 2 cases were good, 5 fair or poor, and 3 died. Especially, 5 cases with massive hemorrhagic infarction obviously resulted in poor prognosis. In our series, induced hypertension therapy for vasospasm was considered as a risk factor. In conclusion, it is necessary to avoid induced hypertension therapy in the remission stage of vasospasm and serial SPECT study might be recommended as a useful prospective method estimating the vasospasm.
Andoh
T
T
Department of Neurosurgery, Gifu University, School of Medicine, Japan.
Imao
Y
Y
Nishimura
Y
Y
Sakai
N
N
Yamada
H
H
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000628:therapy; D002544:Cerebral Infarction / Q000209:etiology* / Q000628:therapy; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous
D004298:Dopamine