395 patients (236 males, mean age 55.6 years: 159 females, mean age 52.2 years) with suspected transient ischaemic attacks or previous strokes underwent intraarterial digital subtraction angiography (IADSA) over a 3-year period ending in March 1991. All procedures were performed via the femoral approach and the majority consisted of arch studies followed by selective catheterization. 253 (64.1%) of the patients had extracranial vascular disease confirmed at angiography. A retrospective analysis of the patients' records was made to extract all possible complications. Complications were defined as any untoward symptoms or signs occurring within 48 h and which could have been related to the angiogram. Neurological complications occurred in 15 (3.89%) patients. 10 (2.5%) patients had transient complications which resolved completely within 24 h. In three (0.8%) patients the neurological deficit was reversible, recovering fully within 6 days. Two (0.52%) patients were left with residual disability from stroke at 10 days. The permanent neurological complication rate is in the lower range of the rates recorded in previous conventional angiographic studies. We conclude that IADSA is a relatively safe and reliable form of investigation in patients with suspected cerebral vascular disease.

A case of spontaneous intra-aneurysmal thrombosis, verified angiographically, is reported in a patient with subarachnoid hemorrhage and without surgical intervention. The frequency of such an occurence and the factors involved are reviewed and discussed.

Four-vessel angiography was repeated in 56 patients with confirmed subarachnoid hemorrhage in whom the initial investigation was negative. Only one aneurysm was demonstrated. The results suggested that, with good technique, careful observation, and a complete four-vessel cerebral angiography, a false negative rate of less than 2% can be achieved. It is suggested that to repeat pan-angiography is seldom justified unless further bleeding episodes occur.

No abstract

Summary. The occurrence and time distribution of spasm and other angiographically demonstrable circulatory disturbances after subarachnoid haemorrhage from aneurysm rupture were investigated in 57 patients on 91 occasions. At the same tim~ hemispherical cerebral bloodflow (CBF) measurements were performed with the intention of finding a prognostically useful parameter or combination of parameters as a guide in the clinical management of the patients. The concept of the delayed appearance of spasm was confirmed. The pattern of other posthaemorrhagic circulatory disturbances conformed with earlier observations. Correlation between spasm and CBF measurements was poor, and CBF using the hemispherical measurement technique, was' found to be of little use in the prognostic evaluation of the patients. Signe precoee de troubles eireulatoires edrdbraux co~-sdcutifs a l'hdmorragie mdningdeRdsumd. Les auteurs ont 6tudi6 chez 57 malades la fr6quence et la r6partition darts le temps du spasme et d'autres troubles circutatoires visibles angiographiquemerit apr6s 91 6pisodes d'h6morragie m6ning6e cons6cu-tire k une rupture d'an6vrysme. En m6me temps les auteurs ont mesur6 le flux sanguin c6r6bral h6misph6-rique en rue de d6terminer un param6tre servant g eltablir le pronostic ou une combinaison de param6tres pour la conduite g tenir dans le traitement des patients. La notion d'apparition diff6r6e du spasme fur confirm6e. Les signes d'autres troubles circulatoires post-h6morragiques concordaient avee les observations ant6rieures. La corr61a-tion entre spasme et mesures du flux sanguin c6r6bral h6misph6rique se r6v61a peu informative et le flux sanguin c6r6bral semblait de peu d'utilit6 dans l'evaluation du pronostic. Fri~he Symptome cerebraler Durchblutungsst6rungen nach SubaraehnoidalblutungenZusammenfassung. Das Auftreten von Spasmen und anderen angiographisch nachweisbaren Zirkulationsst6rungen nach Subarachnoidalblutungen durch die Ruptur eines Aneurysmas wurde bei 57 Patienten untersucht. Gleichzeitig erfolgten CBF-Messungen; dabei zeigte es sich, dab keine Korrelation zwischen Spasmen und den Ergebnissen der CBF-Untersuchungen bestand, so dab die Hirndurchblutungsmessungen nicht zur prognostischen Aussage herangezogen werden k6nnen.Spasm of the intracranial arteries after subarachnoid haemorrhage was investigated by du Boulay (1963) who found a high incidence immediately after the bleeding and observed that in most patients a considerable increase in calibre of the affected arteries occurred within three weeks. The delayed appearance of spasm after subarachnoid haemorrhage from rupture of an intracranial arterial alleurysm was systematically investigated and reported by Kggstr6m et al. (1966). The same temporal distribution of abnormal cerebral circulatory findings during the first month after subarachnoid haemorrhage was also recorded by Bergvall and Galera (1969). At that time, however, only a few determinations of cerebral blood flow were available. In recent years cerebral blood flow (CBF) determinations have been mor...