Value of Computed Tomography in the Prediction of Cerebral Vasospasm after Aneurysm Rupture

Mizukami, Masahiro; Takemae, Toshiki; Tazawa, Toshiaki; Kawase, Takeshi; Matsuzaki, Toshiake

doi:10.1227/00006123-198012000-00008

Cited by 106 publications

(11 citation statements)

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“…They named this phenomenon the "biphasic response." 10 Since then, many reports have noted the same phenomenon in various animal models. In our…”

Section: Discussionmentioning

confidence: 83%

Angiographic study of vasospasm following subarachnoid hemorrhage in monkeys.

Peerless¹,

Fox²,

Komatsu³

et al. 1982

Stroke

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A model for producing chronic cerebral vasospasm in monkeys by injecting autologous blood into the basal cistern is described. Spasm/narrowing was observed by angiography one hour after SAH in 8 out of 10 monkeys and in 5 of these 8, spasm was observed both one and two weeks later. No narrowing of the vessels was observed in the control cases. In monkeys that showed spasm one week after SAH, narrowing of the extracranial vertebral arteries was also observed. Repeated injections of blood at intervals of one and two weeks caused intensification of spasm in the intracranial portion of vertebral arteries and the basilar arteries. It is suggested that cerebral vasospasm following SAH may in part be mediated by a central control mechanism acting through the sympathetic nervous system in that extracranial vessels remote from direct contact with blood showed reactive narrowing. Stroke, Vol 13. No 4. 1982 CEREBRAL ARTERIAL SPASM following sub-arachnoid hemorrhage (SAH) is a most important un-resolved problem in neurosurgery. 1 Clinically, it is reported that cerebral arterial spasm occurs about the 4th to 10th days after SAH; therefore surgery during this period is usually avoided by most people. 2 3 Many unsuccessful attempts have been made to relieve the symptoms or relax the vasospasm but there is still incomplete understanding of the pathogenesis of the condition. For this reason, we initiated this study of SAH in monkeys and observed the changes in the intracranial pressure (ICP), systemic blood pressure (BP) and cerebral angiography with a view to a better understanding of the mechanisms of vasospasm. Methods Fifteen Macaque fascicularis monkeys, weighing between 2.3 kg and 3.2 kg, were used in this study. Three of them were excluded from the data due to technical errors with the radiological and surgical procedures. SAH was created in ten of the remaining animals by injecting fresh autologous arterial blood into the subarachnoid space by means of cisternal puncture. The other two were injected with Elliot's B-solution to serve as controls. The monkeys were given atropine sulphate (0.05 mg/kg), followed by 5-10 mg/ kg of ketamine hydrochloride (IP). After intubation, angiography was carried out. The animals were placed in a supine position with the head fixed such that the orbito-meatal line was horizontal. Bilateral retrograde brachial arteriography was carried out using Conray 60 administered via a mechanical pressure injector at the rate of 2 cc/sec through a Y-connector. Double magnification angiogram films were taken in the basal projection at the rate of 2 films per second for 5 seconds, then 1 film per second for the next 5 seconds. PC0 2 was measured at the time of angiography. After performing baseline angiography prior to the From the Division of Neurosurgery, induced SAH, each monkey was placed on the experimental stand in prone position with head down. The body was tilted 15 degrees forward so that the orbito-meatal line was vertical. Two 22-gauge lumbar needles were inserted into the monkey's basal cis...

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“…They named this phenomenon the "biphasic response." 10 Since then, many reports have noted the same phenomenon in various animal models. In our…”

Section: Discussionmentioning

confidence: 83%

Angiographic study of vasospasm following subarachnoid hemorrhage in monkeys.

Peerless¹,

Fox²,

Komatsu³

et al. 1982

Stroke

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“…Clotted blood may be localized to one or more cisterns or spread throughout the subarachnoid space, depending upon the configuration of the cisterns which can vary from patient to patient 33. Both clinical and experimental studies have demonstrated that the degree and duration of spasm correlate with the amount of locally accumulated blood in the subarachnoid space 9, l a, 15,19,26. The present model in the squirrel monkey represents an effort to achieve an accumulation of blood around the circle of Willis simulating SAH in patients.…”

Section: Discussionmentioning

confidence: 94%

A primate model for acute and late cerebral vasospasm: Angiographic findings

et al. 1992

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A subarachnoid haemorrhage (SAH) in the squirrel monkey was produced by injection of blood via a permanently implanted catheter connected to the cisterna magna and a cannula stereotactically inserted into the interpeduncular cistern. Repeated angiographic examinations of the vertebro-basilar and right internal carotid arteries revealed a biphasic vasospasm with a maximal acute spasm at ten minutes and maximal late spasm at six days after blood injection. The present study has shown that a reproducible biphasic vasospasm can be produced in the squirrel monkey and evaluated by repeated angiographic examinations. The model is suitable in the study of basic mechanisms underlying vasospasm in a primate and, due to the size of the animal, autoradiographic evaluation of the cerebral blood flow and metabolism can be performed at an acceptable cost.

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“…AFs have been considered: a) to increase the rate of intravascular sludging, favouring the formation platelet-fibrin emboli and microthrombi associated with arterial narrowing, and/or b) to worsen or increase the incidence of vasospasm by reducing the clearance of blood from the subarachnoid space, thus allowing the blood to remain in the cisterns and to exert vasoconstrictor effects. It is now well known that a consistent amount of blood-especially clotted blood-in the cisterns, as documented by CT scan, is a finding associated with a significantly higher risk of developing ischaemic deficits from vasospasm 11' 2s, 29,35,47. It has also been suggested that persistence of cisternal blood on CT scan at more than 72 hours from SAH may further increase the risk of vasospasm 35.…”

Section: ) Evaluation Of Complicationsmentioning

confidence: 99%

Rebleeding, ischaemia and hydrocephalus following anti-fibrinolytic treatment for ruptured cerebral aneurysms: A retrospective clinical study

et al. 1988

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350 patients with subarachnoid haemorrhage from aneurysmal rupture--admitted in the years 1966-1983--were selected for a retrospective controlled study on the efficacy of antifibrinolytic therapy (AFT). Patients treated with antifibrinolytics were divided into two groups, according to the day of hospital admission and onset of therapy, respectively between 0 and 3 days (SG 1) and between 4 and 7 days from SAH (SG 2); treated patients (260 cases) received i.v. tranexamic acid (6 gr/day) for at least two weeks. Patients admitted before 1974, not receiving antifibrinolytics (90 cases), were selected as controls and divided into two groups (CG 1 and CG 2), according to the day of admission. In the first study group (admission 0-3 days) the rebleeding rate within 2 weeks was 9% versus 23% in controls (p less than 0.01). The incidence of rebleeding within 3 and 4 weeks was also significantly lower (p less than 0.05) than in controls. No significant difference was observed in the rebleeding rate in treated and untreated patients with late admission (4-7 days). Mortality from rebleeding was 16% in the first study group versus 17% in controls; in the second study group the figure was 6% versus 8% in controls. Seventy-five cases of ischaemic disorders (29%) were registered in treated patients versus 13 cases in controls (14%; p less than 0.01). Thirty-seven patients receiving AFT (14%) developed significant ventricular dilatation requiring shunt insertion, versus one patient in the control groups (1%; p less than 0.001). Final outcome was similar in the 4 groups. In conclusion--according to our data--AFT modifies the behaviour of rebleeding and the patients' course, although it does not modify the outcome after SAH. Clinical use of antifibrinolytic therapy appears still justified in those patients who cannot be operated on in the acute stage after SAH, provided that an associated anti-ischaemic therapy is undertaken.

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Value of Computed Tomography in the Prediction of Cerebral Vasospasm after Aneurysm Rupture

Cited by 106 publications

References 0 publications

Angiographic study of vasospasm following subarachnoid hemorrhage in monkeys.

Angiographic study of vasospasm following subarachnoid hemorrhage in monkeys.

A primate model for acute and late cerebral vasospasm: Angiographic findings

Rebleeding, ischaemia and hydrocephalus following anti-fibrinolytic treatment for ruptured cerebral aneurysms: A retrospective clinical study

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