Clinical aspects of vasospasm.

In summary, clinically significant vasospasm is characterized by several relatively consistent features. Those patients most at risk are adults, of either sex, who have had a subarachnoid hemorrhage about 4 to 9 days previously; who had a poor clinical grade on admission; and in whom a CT scan taken 24 to 48 hours after the ictus showed a thick layer of blood surrounding one or more of the major cerebral vessels. Initially afebrile, affected patients later develop a steady low-grade fever and may have an elevated WBC count, but no infectious source of fever can be found. Patients complain of worsening headache, but not as bad as the one a few days ago; the neck may feel a little more stiff. The pulse is slightly faster than usual, the blood pressure perhaps a bit higher; however, the ECG shows only "cerebral T waves." An antifibrinolytic agent may have been used. The serum sodium concentration has dropped significantly. Such patients need a more thorough examination than usual, directed toward more subtle neurologic signs, and a few extra checks during the day by both physician and nurses, so that we can apply what remedies we have when the patients are just "a little more confused," rather than later, when they are exhibiting decerebrate posturing and coma.