Andoh T, Imao Y, Nishimura Y, Sakai N, Yamada H
Department of Neurosurgery, Gifu University, School of Medicine, Japan.
No To Shinkei. 1989 Oct;41(10):979-85.
Among 528 cases with ruptured aneurysm, 10 cases (1.9%) developed hemorrhagic infarction following vasospasm. There was no obvious relationship between the occurrence and location of aneurysm and the neurological grade on admission. Hemorrhagic infarction occurred from day 9 to 25 (mean day 16) after aneurysmal rupture, and the major neurological symptoms were aggravation of consciousness level, which appeared in 6 cases. On the CT scans of the hemorrhagic infarction following vasospasm, nine cases revealed heterogeneous hemorrhage as assembled of spotty or linear hemorrhages within the ischemic infarction, and 5 cases had massive hemorrhagic infarction in size with mass effect. Although surgical therapy for 2 cases and conservative therapy for 8 cases were performed, the results were unfavorable; ie, 2 cases were good, 5 fair or poor, and 3 died. Especially, 5 cases with massive hemorrhagic infarction obviously resulted in poor prognosis. In our series, induced hypertension therapy for vasospasm was considered as a risk factor. In conclusion, it is necessary to avoid induced hypertension therapy in the remission stage of vasospasm and serial SPECT study might be recommended as a useful prospective method estimating the vasospasm.
在528例动脉瘤破裂病例中，10例（1.9%）在血管痉挛后发生出血性梗死。动脉瘤的发生部位与入院时的神经功能分级之间无明显关系。出血性梗死发生在动脉瘤破裂后的第9天至25天（平均第16天），主要神经症状为意识水平加重，6例出现此症状。在血管痉挛后出血性梗死的CT扫描中，9例显示为缺血性梗死区内斑点状或线状出血聚集而成的不均匀出血，5例有大面积出血性梗死且有占位效应。尽管对2例进行了手术治疗，8例进行了保守治疗，但结果不佳；即2例恢复良好，5例一般或较差，3例死亡。特别是，5例大面积出血性梗死明显导致预后不良。在我们的系列研究中，血管痉挛的诱导性高血压治疗被视为一个危险因素。总之，在血管痉挛缓解期有必要避免诱导性高血压治疗，连续SPECT研究可能是一种有用的前瞻性评估血管痉挛的方法。
