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Intracranial pressure in patients with diffuse cerebral arterial spasm following ruptured intracranial aneurysms

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Summary

Intracranial pressure (ICP) was recorded continuously in 12 pre-operative patients with angiographic evidence of diffuse cerebral arterial spasm due to a ruptured intracranial aneurysm. Recordings were made for 1 to 7 days, starting within 13 days after the haemorrhage. 1. An increased ICP was observed in the first week after subarachnoid haemorrhage (SAH) in 4 of the patients without any signs of angiographic arterial spasm. 2. This initial increase was regularly followed by a depression of ICP in between 7–12 days after SAH. In 11 out of 12 patients such a depression was concomitant with the beginning of arterial spasm. During the period of depressed ICP pattern, 6 patients showed little or no neurological deterioration, whereas 5 patients showed impaired consciousness or neurological deficits. 3. A secondary rise of ICP thereafter always followed due to ischaemic brain swelling or infarction, and was usually associated with a serious neurological deterioration. 4. Continuous ventricular drainage was performed to control the secondary increased ICP in 7 patients who survived, 4 of them with good clinical improvement and 3 with severe neurological deficits. 5. In the stage of depressed ICP, the administration of isoproterenol and steroids is recommended in order to try to alleviate the secondary rise of ICP.

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References

  1. Alexander, S. C., Wollman, H., Cohen, J. P., Chase, P. E., Behar, M., Cerebrovascular response to Paco2 during halothane anaesthesia in man. J. appl. Physiol.19 (1964), 561–565.

    PubMed  Google Scholar 

  2. Arseni, C., Nash, F., Cerebral ischaemia in the course of ruptured aneurysms. Europ. Neurol.1 (1968), 308–323.

    PubMed  Google Scholar 

  3. Birse, S. H., Tom, M. I., Incidence of cerebral infarction associated with ruptured intracranial aneurysms. A study of 8 unoperated cases of anterior cerebral aneurysm. Neurology (Minneap.).10 (1960), 101–106.

    Google Scholar 

  4. Bohm, E., Aronsson, G., Hugosson, R., Grängsjö, G., Ulfendahl, H. R., Wolgast, M., Cerebral circulatory conditions in patients with ruptured aneurysms measured by an intravenous radioactive-indicator technique. Acta Neurol. Scand.44 (1968), 33–42.

    PubMed  Google Scholar 

  5. Buckle, R. M., du Boulay, G., Smith, B., Death due to cerebral vasospasm. J. Neurol. Neurosurg. Psychiat.27 (1964), 440–444.

    PubMed  Google Scholar 

  6. Crompton, M. R., Cerebral infarction following the rupture of cerebral berry aneurysms. Brain87 (1964), 263–280.

    Google Scholar 

  7. Crompton, M. R., The pathogenesis of cerebral infarction following the rupture of cerebral berry aneurysms. Brain87 (1964), 491–510.

    PubMed  Google Scholar 

  8. Farrar, J. K., Jr., Chronic cerebral arterial spasm. The role of intracranial pressure. J. Neurosurg.43 (1975), 408–417.

    PubMed  Google Scholar 

  9. Fox, J. L., Yaşargil, M. G., The relief of intracranial vasospasm: An experimental study with methylprednisolone and cortisol. Surg. Neurol.3 (1975), 214–218.

    PubMed  Google Scholar 

  10. Galera, R., Greitz, T., Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J. Neurosurg.32 (1970), 634–641.

    PubMed  Google Scholar 

  11. Gotoh, F., Meyer, J. S., Takagi, Y., Cerebral effects of hyperventilation in man. Arch. Neurol. (Chicago)12 (1965), 410–423.

    Google Scholar 

  12. Grubb, R. L., Jr., Raichle, M. E., Eichling, J. O., Gado, M. H., Effects of subarachnoid haemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J. Neurosurg.46 (1977), 446–453.

    PubMed  Google Scholar 

  13. Hayashi, M., Marukawa, S., Fujii, H., Kitano, T., Kobayashi, H., Yamamoto, S., Intracranial hypertension in patients with ruptured intracranial aneurysm. J. Neurosurg.46 (1977), 584–590.

    PubMed  Google Scholar 

  14. James, I. M., Changes in cerebral blood flow and in systemic arterial pressure following spontaneous subarachnoid haemorrhage. Clin. Sci.35 (1968), 11–22.

    PubMed  Google Scholar 

  15. Lundberg, N., Kjällquist, Å., Bien, C., Reduction of increased intracranial pressure by hyperventilation. A therapeutic aid in neurological surgery. Acta Psychiat. Neurol. Scand.34 (Suppl. 139) (1959), 1–64.

    Google Scholar 

  16. Lundberg, N., Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiat. Neurol. Scand.36 (Suppl. 149) (1960), 1–193.

    Google Scholar 

  17. McHenry, L. C., Jr., Slocum, H. C., Bivens, H. E., Mayes, H. A., Hayes, G. J., Hyperventilation in awake and anaesthesized man: Effects on cerebral blood flow and cerebral metabolism. Arch. Neurol. (Chicago)12 (1965), 270–277.

    Google Scholar 

  18. McQueen, J. D., Jelsma, L. F., Bacci, F., Pereira, I., Experimental intracranial hypertension due to vascular blockade. J. Neurosurg.33 (1970), 156–166.

    PubMed  Google Scholar 

  19. Nornes, H., Magnaes, B., Intracranial pressure in patients with ruptured saccular aneurysm. J. Neurosurg.36 (1972), 537–547.

    PubMed  Google Scholar 

  20. Rengachery, S. S., Roth, D. A., Andrew, N. W., Mark, H. V., Alteration of the blood brain barrier with hyperventilation. J. Neurosurg.26 (1967), 614–618.

    PubMed  Google Scholar 

  21. Robertson, E. G., Cerebral lesions due to intracranial aneurysms. Brain72 (1949), 150–185.

    Google Scholar 

  22. Schneck, S. A., On the relationship between ruptured intracranial aneurysm and cerebral infarction. Neurology (Minneap.)14 (1964), 691–702.

    Google Scholar 

  23. Schneck, S. A., Kricheff, I. I., Intracranial aneurysm rupture, vasospasm and infarction. Arch. Neurol. (Chicago)11 (1964), 668–680.

    Google Scholar 

  24. Stornelli, S. A., French, J. D., Subarachnoid haemorrhage-factors in prognosis and management. J. Neurosurg.21 (1964), 769–780.

    PubMed  Google Scholar 

  25. Sundbärg, G., Pontén, U., ICP and CSF absorption impairment after subarachnoid haemorrhage. In: Intracranial Pressure III (Beks, J. W. F., Bosch, D. A., Brock, M., eds.), pp. 139–146. Berlin-Heidelberg-New York: Springer. 1976.

    Google Scholar 

  26. Sundt, T. M., Jr., Onofrio, B. M., Merideth, J., Treatment of cerebral vasospasm from subarachnoid haemorrhage with isoproterenol and lidocain hydrochloride. J. Neurosurg.38 (1973), 557–560.

    PubMed  Google Scholar 

  27. Sundt, T. M., Jr., Clinical studies in cerebral vasospasm. In: Subarachnoid Haemorrhage and Cerebrovascular Spasm (Smith, R. R., Robertson, J. D., eds.), pp. 157–176. Springfield, Ill.: Ch. C Thomas. 1975.

    Google Scholar 

  28. Taylor, A. R., Kak, V. K., Cerebral blood flow in subarachnoid haemorrhage. In: Research on the Cerebral Blood Circulation. Third International Salzburg Conference (Meyer, J. S., Lecher, H., Eichhorn, O., eds.), pp. 364–374, 1966.

  29. Tomlinson, B. E., Brain changes in ruptured intracranial aneurysm. J. Clin. Path.12 (1959), 391–399.

    PubMed  Google Scholar 

  30. Wilkins, R. H., Wilkinson, R. H., Odom, G. L., Abnormal brain scans in patients with cerebral arterial spasm. J. Neurosurg.36 (1972), 133–140.

    PubMed  Google Scholar 

  31. Wilkins, R. H., Attempts at treatment of intracranial arterial spasm in animals and human beings. Surg. Neurol.1 (1973), 148–159.

    PubMed  Google Scholar 

  32. Zaren, H. A., Weinstein, J. D., Langfitt, T. W., Experimental ischaemic brain swelling. J. Neurosurg.32 (1970), 227–237.

    PubMed  Google Scholar 

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The authors wish to thank Dr. G. Sundbärg of the Department of Neurosurgery, University of Lund, for review of this manuscript.

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Hayashi, M., Marukawa, S., Fujii, H. et al. Intracranial pressure in patients with diffuse cerebral arterial spasm following ruptured intracranial aneurysms. Acta neurochir 44, 81–95 (1978). https://doi.org/10.1007/BF01401632

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