Adams H P, Kassell N F, Torner J C, Haley E C
Department of Neurology, University of Iowa, Iowa City.
Neurology. 1987 Oct;37(10):1586-91. doi: 10.1212/wnl.37.10.1586.
Cerebral ischemia from vasospasm is a major cause of death and disability following aneurysmal subarachnoid hemorrhage (SAH). This study examines and compares the relative utility of the initial neurologic examination and early CT in predicting cerebral ischemia after SAH. The influence of antifibrinolytic drugs (AFD) in the development of cerebral ischemia was also studied. AFD increased the risk of cerebral ischemia regardless of the admitting neurologic condition or the findings of CT. Among patients given AFD, impaired orientation or alertness was associated with a higher risk of ischemia. Other neurologic signs were not predictive of ischemia. Clinical features were not predictive of ischemia among patients not given AFD. Focal, thick collections of blood on CT were highly predictive of ischemia, whether or not patients received AFD. Admitting CT is the best prognostic indicator for the development of cerebral ischemia after SAH. It should be used to supplement the clinical examination in selecting patients best suited for therapy to prevent vasospasm.
血管痉挛导致的脑缺血是动脉瘤性蛛网膜下腔出血（SAH）后死亡和致残的主要原因。本研究检验并比较了初始神经学检查和早期CT在预测SAH后脑缺血方面的相对效用。还研究了抗纤溶药物（AFD）对脑缺血发生发展的影响。无论入院时的神经状况或CT检查结果如何，AFD都会增加脑缺血风险。在使用AFD的患者中，定向障碍或意识不清与更高的缺血风险相关。其他神经学体征不能预测缺血情况。在未使用AFD的患者中，临床特征不能预测缺血情况。无论患者是否接受AFD治疗，CT上局灶性、浓密的血肿高度提示缺血。入院时的CT是SAH后脑缺血发生发展的最佳预后指标。在选择最适合预防血管痉挛治疗的患者时，应使用CT来补充临床检查。
