[Vascular spasm and cerebral ischemia after meningeal hemorrhage caused by rupture of an aneurysm].
The author discusses the epidemiology, the diagnosis, the clinical and morphological aspects of cerebral vasospasm from his personal experience and a study of the literature. Prediction and diagnosis of vasospasm is possible by evaluation of the amount of blood on CT scan, measuring fibrin breakdown products in the CSF and the findings of early EEG and Transcranial Doppler Sonography. CBF measurement is helpful in following the process of ischemia and deciding the right moment for operation. Early surgery on cerebral aneurysms is advocated in order to prevent rebleeding and for early removal of blood clot from the basal cisterns. If vasospasm and ischemia do develop, energetic treatment with hypervolemia and induced hypertension can be started without fear of rebleeding. Prophylactic intravenous administration of Nimodipine is thought to be of real value. Since the introduction of early surgery by the author 80 patients have been operated within 3 days after S.A.H. The mortality was 11% and the morbidity 7.5%. Management mortality and morbidity for the total group of 209 patients with S.A.H. treated either medically or surgically were 23.5% and 6% respectively. If one excludes the 18 patients that died within 24 hours the mortality was 15.6%.
D002545:Brain Ischemia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002533:Cerebral Angiography; D004569:Electroencephalography; D005338:Fibrin Fibrinogen Degradation Products / Q000134:cerebrospinal fluid; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000628:therapy; D009539:Nicotinic Acids / Q000627:therapeutic use; D009553:Nimodipine; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D002121:Calcium Channel Blockers; D005338:Fibrin Fibrinogen Degradation Products; D009539:Nicotinic Acids; D009553:Nimodipine
Spasme vasculaire et ischémie cérébrale après hémorragie méningée par rupture anévrysmale.