EARLY TREATMENT OF SUBARACHNOID HEMORRHAGE AFTER PREVENTING RERUPTUREOF AN ANEURYSM

Twelve patients with Hunt and Hess neurological Grades III to V underw ent thrombosis of aneurysms using cellulose acetate polymer within 23 hours of aneurysm rupture. On computerized tomography (CT), nine of th ese patients had diffuse or localized thick subarachnoid blood clots, two had diffuse thin clots, and one had intraventricular clots. Immedi ately after thrombosis, all patients were administered tissue plasmino gen activator (TPA) through spinal or ventricular catheters. The press ure of the lumbar cerebrospinal fluid was maintained at 100 to 150 mm H2O. The TPA was given as multiple injections of 2 mg on Day 0 and 1 t o 2 mg on the following 1 to 2 days. In two patients the second inject ion of TPA was not given because of severe brain damage resulting from the initial subarachnoid hemorrhage. Ten patients showed complete cle arance of the cisternal clot on CT within 72 hours after thrombosis. S even partially thrombosed aneurysms and five multiple aneurysms were c lipped during delayed surgery. Only one patient experienced mild vasos pasm as shown on the follow-up angiogram. Eight patients improved clin ically and had a good recovery, two had severe disability, and two die d. Urgent thrombosis of a ruptured aneurysm followed by immediate post thrombotic administration of TPA may be a safe and reasonable means of preventing vasospasm and improving patient outcome.