PATHOPHYSIOLOGIGAL ASPECTS OF ACUTE STAGE PATIENTS WITH RUPTURED INTRACRANIAL ANEURYSMS PART II: RELATIONSHIPS BETWEEN NEUROLOGICAL PROGNOSIS AND SEQUENTIAL CHANGES OF CEREBRAL BLOOD FLOW DYNAMICS Yoshiharu Sakurai 1,2 , Zentaro Ito 1 , Kazuo Uemura 3 1Division of Surgical Neurology, Research Institute of Brain and Blood Vessels 3Division of Radiology, Research Institute of Brain and Blood Vessels pp.1213-1221
Published Date 1975/11/1
DOI https://doi.org/10.11477/mf.1406203805
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Relationships between cerebral blood fiow (CBF)dynamics and neurological deficits were studied in14 patients with subarachnoid hemorrhage due toruptured intracranial aneurysm.

CBF in acute stage of the subjects was examinedby 133Xe clearance method using a 6 channel detectorunit. Mean hemispheric CBF, regional CBF, vascularresponse for hypercapnea and function of auto-regulation was evaluated in reference to neurologicalsymptoms.

The sites of their ruptured aneurysms wereanterior communicating artery in 6 cases, internalcarotid artery in 3, and middle cerebral artery in5. In thirteen cases of them, intracranial directoperations were performed.

The materials could be devided into 4 groupswith 2 subgroups by their neurological prognosis.Group I was a severe case, who was died soonafter bleeding. Mean CBF of the case was 20.6 ml/100g/min. with diffuse ischemia.

Group II was cases with poor prognosis. Further-more, this group was devided into 2 subgroups(group II-a, and group II-b). The prognosis ofgroup II-a was evaluated as severe neurologicaldeficit and vegetative state in chronic stage, butpatients belonging to group II-b were resulted tosevere neurological deficit without vegetative state.

In group II-a, the CBF pattern showed "globalluxury perfusion" in acute state, followed bycontinous vasomotor paralysis and diffuse ischemiain chronic stage. In group II-b, "global luxuryperfusion" and chronic diffuse ischemia was notrecognized, but vasomotor paralysis persisted longtime.

Group III left slight neurological deficit, but groupIV had not any neurological abnormality. Thevalues of the mean CBF of group III and IV werealmost normal. In group III and IV, vasomotorparalysis was milder than group II. The differenceof hemodynamics in these two groups were severityand recovery pattern of focal abnormality andvascular response.

"Global luxury perfusion", which was frequentlyobserved in acute stage of the group II-a cases,was note worthy. It was discussed in the con-nection with severe brain damage and risk of re-rupture of the aneurysm.

From the clinical view points described above, itshould be apparent that the neurologinal prognosishas a close relation to sequential changes of CBFdynamics in acute stage patients with rupturedintracranial aneurysms. Furthermore, sequentialobservations of CBF dynamics shoud be needed todetermine the optimum timing and selection ofdirect operation from ruptured intracranial an-eurysms in acute stage.

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


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