TRAUMATIC SUBARACHNOID HEMORRHAGE AS A PREDICTABLE INDICATOR OF DELAYED ISCHEMIC SYMPTOMS

This report provides findings of an investigation of the influence of traumatic subarachnoid hemorrhage on the development of delayed cerebr al ischemia caused by vasospasm. The authors prospectively studied 130 patients with closed-head trauma, who exhibited subarachnoid blood on admission computerized tomography (CT) scans. Ten (7.7%) of these pat ients developed delayed ischemic symptoms between Days 4 and 16 after the head injury. They consisted of three (3.0%) of 101 patients with s mall amounts of subarachnoid blood and seven (24.1%) of 29 patients wi th massive quanti ties of subarachnoid blood on admission CT scans. In each of the 10 patients, severe vasospasm was demonstrated by angiogr aphy performed soon after development of ischemic symptoms. There was a close correlation between the main site of the subarachnoid blood an d the location of severe vasospasm. In seven of the patients, follow-u p CT scans showed development of focal ischemic areas in the cerebral territories corresponding to the vasospastic arteries. These results d emonstrate that traumatic subarachnoid hemorrhage, especially if massi ve, is a predictable indicator of delayed ischemic symptoms.