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Cerebral vasospasm in elderly patients treated by early operation for ruptured intracranial aneurysms

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Summary

Cerebral vasospasm in elderly patients was studied under strict criteria. A total of 145 patients, who had been operated on in the acute stage after subarachnoid haemorrhage, were classified into two age groups. Those aged 59 years or younger were in group 1 (76 cases, 52%), and those aged 60 years or older were in group 2 (69 cases, 48%). The severities of both the subarachnoid haemorrhage on computed tomography scan and the angiographic vasospasm were graded from 0 to IV. Close correlations were found in both groups for the angiographic vasospasm grades to the incidences of both symptomatic vasospasm and low-density areas on computed tomography scan. Angiographic vasospasm was observed in 95% of group 1 and in 91% of group 2 patients. The incidences of permanent symptomatic vasospasm were 14% in group 1 and 19% in group 2. Low-density areas on computed tomography occurred in 16% of group 1 and in 17% of group 2. Generally, the higher the clinical grades and/or the higher the subarachnoid haemorrhage grades, the more severe were the vasospasms. These tendencies were more apparent in subarachnoid haemorrhage grading. The mortality rates were 8% in group 1 and 17% in group 2. However, when both the clinical grades and the subarachnoid haemorrhage grades were analyzed, there were no significant differences between groups 1 and 2 in either the severity of vasospasm or in the outcome.

It must be concluded that neither the angiographic vasospasm grades nor the incidence of symptomatic vasospasm are significantly effected by age.

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References

  1. Allcock JM, Drake CG (1965) Ruptured intracranial aneurysms: the role of arterial spasm. J Neurosurg 22: 21–29

    PubMed  Google Scholar 

  2. Auer LM (1984) Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15: 57–66

    PubMed  Google Scholar 

  3. Drake CG (1988) Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid haemorrhage grading scale. J Neurosurg 68: 985–986

    PubMed  Google Scholar 

  4. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid haemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9

    PubMed  Google Scholar 

  5. Fisher CM, Roberson GH, Ojemann RG (1977) Cerebralbal vasospasm with ruptured saccular aneurysm — the clinical manifestations. Neurosurgery 1: 245–248

    PubMed  Google Scholar 

  6. Flechter TM, Taveras JM, Pool JL (1959) Cerbral vasospasm in angiography for intracranial aneurysms. Arch Neurol 1: 38–47

    PubMed  Google Scholar 

  7. Graf CJ, Nibbelink DW (1974) Cooperative study of intracranial aneurysms and subarachnoid haemorrhage. Report of a randomized treatment study. III. Intracranial surgery. Stroke 5: 559–601

    Google Scholar 

  8. Heros RC, Zervas NT, Varsos V (1983) Cerebral vasospasm after subarachnoid haemorrhage: an update. Ann Neurol 14: 599–608

    PubMed  Google Scholar 

  9. Inagawa T (1990) Effect of early operation on cerebral vasospasm. Surg Neurol 33: 239–246

    PubMed  Google Scholar 

  10. Inagawa T (1990) Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 106: 119–126

    Google Scholar 

  11. Inagawa T (1991) Cerebral vasospasm in elderly patients with ruptured intracranial aneurysms. Surg Neurol 36: 91–98

    PubMed  Google Scholar 

  12. Inagawa T, Kamiya K, Matsuda Y (1991) Effect of continuous cisternal drainage on cerebral vasospasm. Acta Neurochir (Wien) 112: 28–36

    Google Scholar 

  13. Inagawa T, Kamiya K, Ogasawara H, Yano T (1987) Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28: 93–99

    PubMed  Google Scholar 

  14. Inagawa T Takahashi M, Aoki H, Ishikawa S, Yoshimoto H (1988) Aneurysmal subarachnoid haemorrhage in Izumo City and Shimane Prefectural of Japan. Outcome. Stroke 19: 176–180

    PubMed  Google Scholar 

  15. Inagawa T, Yamamoto M, Kamiya K (1990) Effect of clot removal on cerebral vasospasm. J Neurosurg 72: 224–230

    PubMed  Google Scholar 

  16. Inagawa T, Yamamoto M, Kamiya K, Ogasawara H (1988) Management of elderly patients with aneurysmal subarachnoid haemorrhage. J Neurosurg 69: 332–339

    PubMed  Google Scholar 

  17. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet i: 480–484

    Google Scholar 

  18. Koike T, Ishii R, Ihara I, Kameyama S, Takeuchi S, Kobayashi K (1981) Clinical analysis of cerebral vasospasm following subarachnoid haemorrhage: Aging and cerebral vasospasm. No To Shinkei (Jpn) 33: 499–504

    Google Scholar 

  19. Kwak R, Niizuma H, Ohi T, Suzuki J (1979) Angiographic study of cerebral vasospasm following rupture of intracranial aneurysms: Part I. time of the appearance. Surg Neurol 11: 257–262

    PubMed  Google Scholar 

  20. Mizukami M, Kawase T, Usami T, Tazawa T (1982) Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10: 301–307

    PubMed  Google Scholar 

  21. Mizukami M, Takemae T, Tazawa T, Kawase T, Matsuzaki T (1980) Value of computed tomography in the prediction of cerebral vasospasm after aneurysm rupture. Neurosurgery 7: 583–586

    PubMed  Google Scholar 

  22. Mohsen F, Pomonis S, Illingworth R (1984) Prediction of delayed cerebral ischemia after subarachnoid haemorrhage by computed tomography. J Neurol Neurosurg Psychiatry 47: 1197–1202

    PubMed  Google Scholar 

  23. Ohta T, Kawamura J, Osaka K, Kajikawa H, Handa H (1969) Angiographic classification of so-called cerebral vasospasm correlation between existence of vasospasm and postoperative prognosis in subarachnoid haemorrhage. No To Shinkei (Jpn) 21: 1019–1027

    Google Scholar 

  24. Pasqualin A, Rosta L, Da Pian R, Cavazzani P, Scienza R (1984) Role of computed tomography in the management of vasospasm after subarachnoid haemorrhage. Neurosurgery 15: 344–353

    PubMed  Google Scholar 

  25. Saito I, Shigeno T, Aritake K, Tanishima T, Sano K (1979) Vasospasm assessed by angiography and computerized tomography. J Neurosurg 51: 466–475

    PubMed  Google Scholar 

  26. Saito I, Ueda Y, Sano K (1977) Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47: 412–429

    PubMed  Google Scholar 

  27. Sano K, Saito I (1978) Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta Neurochir (Wien) 41: 49–60

    Google Scholar 

  28. Schneck SA, Kricheff II (1964) Intracranial aneurysm rupture, vasospasm, and infarction. Arch Neurol 11: 668–680

    PubMed  Google Scholar 

  29. Suzuki A, Yasui N, Hadeishi H, Sayama I, Asakura K (1988) Cerebral vasospasm in aged patients with ruptured intracranial aneurysms. Neurol Med Chir (Jpn) 28: 786–790

    Google Scholar 

  30. Suzuki J, Yoshimoto T, Onuma T (1978) Early operation for ruptured intracranial aneurysms-study of 31 cases operated on within the first four days after ruptured aneurysm. Neurol Med Chir 18 (Part I): 83–89

    Google Scholar 

  31. Van der Werf AJM (1972) Clinical aspects of subarachnoid haemorrhage and significance of vasospasm. Psychiatr Neurol Neurochir 75: 411–415

    PubMed  Google Scholar 

  32. Weir B, Grace M, Hansen J, Rothberg C (1978) Time course of vasopasm in man. J Neurosurg 48: 173–178

    PubMed  Google Scholar 

  33. Wilkins RH, Alexander JA, Odom GL (1968) Intracranial arterial spasm: a clinical analysis. J Neurosurg 29: 121–134

    PubMed  Google Scholar 

Download references

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  1. Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan

    T. Inagawa

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  1. T. Inagawa
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Inagawa, T. Cerebral vasospasm in elderly patients treated by early operation for ruptured intracranial aneurysms. Acta neurochir 115, 79–85 (1992). https://doi.org/10.1007/BF01406362

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