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.
Similar content being viewed by others
References
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.
Arseni, C., Nash, F., Cerebral ischaemia in the course of ruptured aneurysms. Europ. Neurol.1 (1968), 308–323.
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.
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.
Buckle, R. M., du Boulay, G., Smith, B., Death due to cerebral vasospasm. J. Neurol. Neurosurg. Psychiat.27 (1964), 440–444.
Crompton, M. R., Cerebral infarction following the rupture of cerebral berry aneurysms. Brain87 (1964), 263–280.
Crompton, M. R., The pathogenesis of cerebral infarction following the rupture of cerebral berry aneurysms. Brain87 (1964), 491–510.
Farrar, J. K., Jr., Chronic cerebral arterial spasm. The role of intracranial pressure. J. Neurosurg.43 (1975), 408–417.
Fox, J. L., Yaşargil, M. G., The relief of intracranial vasospasm: An experimental study with methylprednisolone and cortisol. Surg. Neurol.3 (1975), 214–218.
Galera, R., Greitz, T., Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J. Neurosurg.32 (1970), 634–641.
Gotoh, F., Meyer, J. S., Takagi, Y., Cerebral effects of hyperventilation in man. Arch. Neurol. (Chicago)12 (1965), 410–423.
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.
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.
James, I. M., Changes in cerebral blood flow and in systemic arterial pressure following spontaneous subarachnoid haemorrhage. Clin. Sci.35 (1968), 11–22.
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.
Lundberg, N., Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiat. Neurol. Scand.36 (Suppl. 149) (1960), 1–193.
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.
McQueen, J. D., Jelsma, L. F., Bacci, F., Pereira, I., Experimental intracranial hypertension due to vascular blockade. J. Neurosurg.33 (1970), 156–166.
Nornes, H., Magnaes, B., Intracranial pressure in patients with ruptured saccular aneurysm. J. Neurosurg.36 (1972), 537–547.
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.
Robertson, E. G., Cerebral lesions due to intracranial aneurysms. Brain72 (1949), 150–185.
Schneck, S. A., On the relationship between ruptured intracranial aneurysm and cerebral infarction. Neurology (Minneap.)14 (1964), 691–702.
Schneck, S. A., Kricheff, I. I., Intracranial aneurysm rupture, vasospasm and infarction. Arch. Neurol. (Chicago)11 (1964), 668–680.
Stornelli, S. A., French, J. D., Subarachnoid haemorrhage-factors in prognosis and management. J. Neurosurg.21 (1964), 769–780.
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.
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.
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.
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.
Tomlinson, B. E., Brain changes in ruptured intracranial aneurysm. J. Clin. Path.12 (1959), 391–399.
Wilkins, R. H., Wilkinson, R. H., Odom, G. L., Abnormal brain scans in patients with cerebral arterial spasm. J. Neurosurg.36 (1972), 133–140.
Wilkins, R. H., Attempts at treatment of intracranial arterial spasm in animals and human beings. Surg. Neurol.1 (1973), 148–159.
Zaren, H. A., Weinstein, J. D., Langfitt, T. W., Experimental ischaemic brain swelling. J. Neurosurg.32 (1970), 227–237.
Author information
Authors and Affiliations
Additional information
The authors wish to thank Dr. G. Sundbärg of the Department of Neurosurgery, University of Lund, for review of this manuscript.
Rights and permissions
About this article
Cite this article
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
Issue Date:
DOI: https://doi.org/10.1007/BF01401632