Sequential changes of cerebral blood flow after aneurysmal subarachnoid haemorrhage

Abstract

A total of 226 measurements of cerebral blood flow (CBF) were performed in 96 postoperative patients with aneurysmal subarachnoid haemorrhage (SAH). The global CBF was significantly reduced in the first week after SAH, and the extent of the CBF reduction was less in the patients with good outcome than in those with fair/poor outcome. The good outcome patients showed a progressive increase in CBF in the following 3 weeks. Although the CBF decreased further in the second week in some of those patients, it turned to a steady increase thereafter. On the other hand, in the fair/poor outcome patients CBF remained far below the normal control value for at least 3 months after SAH. When looking into the effect of age on CBF in the patients with good outcome, those in their thirties and forties had a significantly reduced CBF during the first 2 weeks, whereas in those in their fifties and sixties a significant reduction persisted for 3 months to 1 year after SAH. Management of the older patients needs special attention even if they are apparently in good clinical condition, since the CBF threshold to ischaemia is diminished.

Hypertonic fluid resuscitation from subarachnoid hemorrhage in rats: A comparison between small volume resuscitation and mannitol

“…10.016 CBF to 36 -85% of controls in experimental [3,5,7] and clinical studies [7,9,10]. The reduction of CBF correlated with the intensity of bleeding-size of hematoma -and with the clinical outcome of the surviving patients [9,[11][12][13].…”

Effect of Hypervolemic Therapy on Cerebral Blood Flow After Subarachnoid Hemorrhage

“…Others have also identified poor Hunt-Hess grade 37,53 and low CBF 11,12,54,55 as predictors of poor outcome after SAH.…”

Longitudinal study of cerebral blood flow following early or delayed surgery for ruptured intracranial aneurysms

“…Several studies have pointed out a significant relationship between CBF and either clinical grade following aneurysmal subarachnoid haemorrhage 2' 8, 2~, 22, 27, 3;, or final outcome TM 14,16. Depression of flow is more prone to occur in the early phase after bleeding 6, 7, 9-~x, with possible impairment of autoregulation and CO2 reactivity, particularly in patients in the worst clinical grades 3, 5, ~9, 24, 3o…”

“…Since the surgical intervention may cause further depression of flow 6 ' 10, there has been concern about the effects of early surgery on already compromised cerebral haemodynamics 15, There is, however, little information on the time course of changes in cerebral blood flow (CBF) of surgically treated patients 16. The purpose of the present report was to assess whether early operations, compared with delayed surgery, resulted in long lasting effects on cerebral circulation.…”