FACTORS RELATED TO LEVEL OF CONSCIOUSNESS IN THE ACUTE STAGE OF RUPTURED INTRACRANIAL ANEURYSMS Zentaro Ito 1 , Shigeru Matsuoka 1 , Takashi Moriyama 1 , Ryushu Hen 1 , Kenji Nakajima 1 1Division of Surgical Neurology Research Institute of Brain and Blood Vessels pp.895-901
Published Date 1975/8/1
DOI https://doi.org/10.11477/mf.1406203759
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Factors complicating disturbance of consciousness were analysed and some neurosurgical procedures were carried out to improve level of consciousness in 58 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms admitted within 3 days after bleeding from January, 1972 to December, 1973.

The sites of ruptured aneurysm of this series were internal carotid artery in 21 cases, anterior communicating artery or A1 porton of anterior cerebral artery (ACA) in 18, middle cerebral artery in 13, A2 portion of ACA in 2 and teritory ofvertebral artery in 4 cases.

At admission, we had 5 deep comatose, 6 comatose, 9 semicomatose, 11 stuporous, 16 somnolent and 11 alert patients. In the various state of consciousness, the relationships between disturbance of con-sciousness and some values of clinical examinations were analysed statistically. The factors in clinical examinations were regional cerebral blood flow dynamics measured by Xe133 clearance method, cerebral circulation time, grade of ventricular en-largement and vasospasm by serial angiography, intracerebral hematom and grade of SAH by autopsy or operation, and cerebrospinal fluid pressure by lumbar puncture. Out of those factors, intracerebral hematomas were revealed in 55% of deep comatose or semicomatose patients but in 13% of stuporous or alert patients. Mortality rate of patients with intracerebral hematom were 100% in conservatively treated cases but 10% in surgically.

The values of ventriculocranial (VC) index, in which showed size of lateral ventricle, were 0.295 in comatose and O.268±0.015 in alert patients. Only by continuous ventricular drainage and exter-nal decompression, decrease of VC index and im-provement of level of consciousness were obtained simultaneously.

Cerebral blood flow (CBF) measurements were performed in 14 cases without intracerebral hematom. The values of CBF were 20.6 (ml/100g/min) in a comatose case but 45.7±13.9 (ml/100g/min) in somnolent patients.

Namely, intracerebral hematom (P<O.01), grade of ventricular dilatation (P<0.05) and cerebral blood flow decrease (P<0.02) could be extraced as factors which were significantly related to disturbance of consciousness at acute stage of SAH. Although other factors had no direct correlation with level of consciousness but indirect relation to significant factors complicating disturbance of consciousness.

To improve level of consciousness and cerebral blood flow dynamics, some neurosurgical procedures might be needed, such as evacuation of intracerebral hematom, continuous ventricular drainage and external decompression as soon as possible after onset of SAH.

Copyright © 1975, Igaku-Shoin Ltd. All rights reserved.


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