[Fibrinolytic activity of cerebrospinal fluid in subarachnoid hemorrhage (author's transl)].

This study was aimed to investigate the correlation between recurrent hemorrhage of ruptured intracranial aneurysm and local fibrinolytic activity of aneurysmal fibrin plug. The fibrinolytic activity of cerebrospinal fluid (CSF) was investigated in 63 patients with various neurological diseases by means of modified fibrin plate method. No plasmin was elicited in normal CSF, however, it was confirmed that CSF contained an incomplete activator which became a complete activator inthe presence of streptokinase, and plasminogen was identified in the presence of urokinase. In 26 cases of subarachnoid hemorrhage, the fibrinolytic activity of CSF occurred in the patients within two weeks following hemorrhagic ictus. In almost cases, the fibrinolytic activity of CSF was not increased in the first three weeks after the onset of hemorrhage. This result agreed with the fact that rebleeding of intracranial aneurysm tended to occur within two weeks after the hemorrhage. Therefore, intensive antifibrinolytic therapy for two weeks after onset of hemorrhage is necessary in order to prevent recurrent hemorrhage of intracranial aneurysm, and its doses should be sufficient to inhibit local fibinolysis. It has been suggested that the local fibrinolysis after subarachnoid hemorrhage would be caused by activators released from damaged surrounding brain tissues. Furthermore, it is strongly suggested from the result of our in vitro experiments that coexistence of CSF and blood play an important role to increase local fibrinolysis.