On the influence of disturbance of cerebral circuration for the occurrence of vasospasm in acute stage of SAH.
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We investigated the influences of acute cerebral perfusion disorder and the occurrence and extent of symptomatic vasospasm. In 63 SAH patients, excluding ventricular puncture and complicated intracerebral hematoma, the measurement of cerebral blood flow (CBF) by <SUP>133</SUP>Xe bolus injection was effected within the first 72 hours after the crisis. CBF was denoted as mean hemispheric gray matter blood flow (MFG) (ml/100g/min). According to MFG, the 63 patients were divided into the following three groups : Group A-17 patients with normal or increased values (MFG>70), Group B-30 patients with slightly decreased values (50<MFG≤70), and Group C-16 patients with very decreased values (MFG≤50). The symptomatic vasospasm (SVS) was defined as follows : <BR>cases with findings of re-ruptured aneurysm on CT, decreased level of consciousness without an exacerbated hydrocephalia or localized cerebral symptom were designated as SVS-positive and divided into slight SVS, transient neurological deterioration; moderate SVS, permanent slight neurological deficit; and severe SVS, permanent severe neurological deficit or death.<BR>The frequencies of SVS were as follows : Group A 17.7%, Group B 76.7%, and Group C 100%. In Groups A and B, no cases of severe SVS were observed, however in Group C 84.5% of the cases showed severe SVS.<BR>In the 63 cases, in cases showing Fisher's Type 3 CT findings and those showing Hunt and Kosnik Grade III and IV upon hospitalization, severe SVS appeared in only 41.4% and 38.2%, respectively.<BR>Furthermore, dividing the cases that belonged to Fisher's Type 3 CT and Hunt and Kosnik Grade III and IV upon hospitalization into a group under acute MFG 50 and a group over MFG 50, 90% in the former group had an unfavorable prognosis and showed a final picture of an uncomfortable death.<BR>It is well known that acute changes in the cerebral circulation and metabolism appear simultaneously with SAH crisis. From our results, it was assumed that such a cerebral disorder of circulation and metabolism at the early stage of SAH may exert a great influence on the occurrence of symptomatic vasospasm and the degree of this severity.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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