Fisher C M, Kistler J P, Davis J M
Neurosurgery. 1980 Jan;6(1):1-9. doi: 10.1227/00006123-198001000-00001.
In 47 cases of verified ruptured saccular aneurysm, we investigated the relationship of the amount and distribution of subarachnoid blood detected by computerized tomography to the later development of cerebral vasospasm. When the subarachnoid blood was not detected or was distributed diffusely, severe vasospasm was almost never encounters (1 of 18 cases). In the presence of subarachnoid blood clots larger than 5 X 3 mm (measured on the reproduced images) or layers of blood 1 mm or more thick in fissures and vertical cisterns, severe spasm followed almost invariably (23 of 24 cases). There was an almost exact correspondence between the site of the major subarachnoid blood clots and the location of severe vasospasm. Every patient with severe vasospasm manifested delayed symptoms and signs. Excellent correlation existed between the particular artery in vasospasm and the delayed clinical syndrome. Severe vasospasm involved the anterior cerebral artery in 20 cases and the middle cerebral artery in only 14. As the grading system used is partly subjective, the findings should be regarded as preliminary. The results, if confirmed, indicate that blood localized in the subarachnoid space in sufficient amount at specific sites is the only important etiological factor in vasospasm. It should be possible to identify patients in jeopardy from vasospasm and institute early preventive measures. (Neurosurgery, 6: 1--9, 1980)
在47例已证实的囊状动脉瘤破裂病例中，我们研究了计算机断层扫描所检测到的蛛网膜下腔出血量及分布与随后发生的脑血管痉挛之间的关系。当未检测到蛛网膜下腔出血或出血呈弥漫性分布时，几乎从未发生严重的血管痉挛（18例中有1例）。当蛛网膜下腔存在大于5×3毫米（在复制图像上测量）的血凝块或脑沟和垂直脑池中厚度达1毫米或更厚的血液层时，几乎总会继发严重的痉挛（24例中有23例）。主要蛛网膜下腔血凝块的部位与严重血管痉挛的位置几乎完全对应。每例发生严重血管痉挛的患者均出现了延迟性症状和体征。血管痉挛所涉及的特定动脉与延迟性临床综合征之间存在极佳的相关性。严重血管痉挛累及大脑前动脉20例，累及大脑中动脉仅14例。由于所使用的分级系统部分具有主观性，这些发现应被视为初步的。如果这些结果得到证实，则表明蛛网膜下腔中特定部位存在足够量的局部血液是血管痉挛唯一重要的病因因素。应该能够识别出有血管痉挛风险的患者并尽早采取预防措施。（《神经外科学》，6: 1 - 9，1980年）
