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Diagnosis and treatment of factors complicating subarachnoid hemorrhage

Diagnostic et traitement des facteurs aggravant de l'hémorragie méningée

Die Diagnose und die Behandlung von Faktoren, die eine Subarachnoideal-Blutung komplizieren

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Summary

Regional cerebral blood flow (rCBF) measurements in the steady state and after activation techniques were combined with serial cerebral arteriography in patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm. Such information was useful in selecting and evaluating the effectiveness of treatment for complicating factors such as cerebral vasospasm, cerebral edema, acute and chronic hydrocephalus and intracerebral hematoma. Regional cerebral blood flow values were found to be reduced in patients after SAH and correlated well with the neurological status and the complicating factors listed above. When vasospasm was relieved by phenoxybenzamine (PBZ), rCBF did not increase although regional cerebral blood volume did, suggesting that other factors may be more important for the reduction of rCBF such as cerebral edema and communicating hydrocephalus. When cerebral edema and acute hydrocephalus were treated by either intravenous glycerol or lumbar cerebrospinal fluid drainage, RCBF increased.

Résumé

Les mesures du flux sanguin cérébral régional au repos et après technique d'activation furent associées à la sério-angiographie cérébrale chez des malades présentant une hémorragie méningée due à une rupture anévrysmale. Une telle étude était utile dans le choix et l'évaluation de l'efficacité du traitement des facteurs d'aggravation tels que les spasmes cérébraux, l'oedème cérébral, l'hydrocéphalie aigüe et chronique et l'hématome intracébr'ebral. Les valeurs du flux sanguin cérébral régional trouvées furent plus faibles chez des malades après hémorragie méningée, en rapport tant avec l'état neurologique qu'avec les facteurs aggravants mentionnés ci-dessus. Lorsque le spasme vasculaire était levé par la Phénoxybenzamine, le flux sanguin cérébral régional était constant bien que le volume sanguin cérébral régional augmentait, suggérant que d'autres facteurs peuvent être plus importants pour la réduction du flux sanguin céréphalie communiquante. Lorsqu'on traitait l'oedème cérébral et l'hydrocéphalie aigüe soit par Glycerol intra-veineux, soit par drainage lombaire du liquide céphalorachidien, le flux sanguin cérébral régional augmentait.

Zusammenfassung

Ausführliche Untersuchungen des CBF in Kombination mit der Serien-Angiographie bei Patienten mit einer Subarachnoideal-Blutung. Dabei sollten die Komplikationsfaktoren, wie Gefäßspasmus, Hirnödem, akuter und chronischer Hydrocephalus, intracerebrales Haematom, bestimmt werden. Der regionale Hirndurchflußwert war bei allen Patienten nach einer Subarachnoideal-Blutung reduziert. Dabei konnte nachgewiesen werden, daß das Hirnödem und der Hydrocephalus eine besondere Bedeutung für die Reduktion des CBF haben. Nach der Behandlung dieser Komplikationen kam es zu einem Anstieg der Hirndurchblutung.

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Authors and Affiliations

  1. Department of Neurology, Baylor College of Medicine, and the Baylor-Methodist Center for Cerebrovascular Research, Houston, Texas, USA

    N. T. Mathew, J. S. Meyer & A. Hartmann

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  1. N. T. Mathew
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  2. J. S. Meyer
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  3. A. Hartmann
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Additional information

Supported by grant NS 09287 from the National Institute of Neurological Diseases and Stroke, and in part by grant RR 00350 from the General Clinical Research Centers Branch, Division of Research Resources, National Institutes of Health, Bethesda, Maryland.

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Mathew, N.T., Meyer, J.S. & Hartmann, A. Diagnosis and treatment of factors complicating subarachnoid hemorrhage. Neuroradiology 6, 237–245 (1974). https://doi.org/10.1007/BF00345783

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