CEREBRAL VASOSPASM AFTER SUBARACHNOID HEMORRHAGE OF UNKNOWN ETIOLOGY - A CLINICAL AND TRANSCRANIAL DOPPLER STUDY

Sixteen patients (6 women, 10 men; mean age: 52.5 years) suffering fro m spontaneous subarachnoid haemorrhage (SAH) of unknown origin underwe nt a protocol of initial and then weekly computed tomography (CT), ini tial four-vessel digital subtraction angiography (DSA) and at least on e control pancerebral DSA. Fourteen patients had magnetic resonance im aging before undergoing first control DSA. All patients had calcium-an tagonists (Nimodipine) via a central venous catheter, were kept on the neurosurgical intensive care unit and followed daily with transcrania l Doppler ultrasonography (TCD). One patient (6.3%) developed moderate and 5 (31.1%) developed severe cerebral vasospasm as documented with TCD and exhibited deterioration of their level of consciousness. These 6 patients were treated with induced hypertension, hypervolaemia and haemodilution. Their blood flow velocities were elevated for a mean of 8 (5-17) days with a peak after 12.5 (9-17) days following SAH. No co mplications due to treatment were noted. One patient of the non-vasosp astic group died of pulmonary embolism, another patient had an ischaem ic incident during angiography, which has led to permanent disability. On follow-up 2-24 months after SAH 14 patients had returned to their premorbid state. It is concluded that patients suffering from SAH of u nknown origin should undergo repealed angiographic investigation and s ubsequent daily monitoring of their neurologic status including daily TCD recordings so that haemodynamic treatment can be established in th e event of cerebral vasospasm, which may occur in up to one third of t hese patients.