Cerebral metabolism in patients with ruptured aneurysms (author's transl)

Abstract

Pathophysiological conditions following rupture of an aneurysm have not been sufficiently clarified. The present study was intended to analyze cerebral blood flow (CBF) and metabolism in patients with ruptured aneurysm sequentially. CBF measurements were performed 95 times on 53 patients by 133Xe intracarotid injection method. O2 content was measured by a spectrophotometer and gas analyzer. Glucose, lactate, and pyruvate were measured by enzymatic methods. The reduction of CBF, CMRO2, and CMRglucose and the increase of CVR correlated well with the severity of the clinical grade of Hunt & Hess in patients within 30 days after subarachnoid hemorrhage (SAH). It was found that the cerebral metabolism of the patients with diffuse type spasms inclined to anaerobic glycolysis. The reduction of CBF and CMRO2 observed within 3 days after SAH, when spasm was rarely observed in carotid angiography, was probably caused by disturbances in micro-circulation. Discrepancies of the cerebral metabolism and CBF, for example, reduction of CMRO2 with almost normal CBF in Grade I and II, was observed in the period of recovery. High CSF pressure and high CSF lactate correlated relatively well with the severity of the clinical grades. CSF pressure and lactate content in CSF decreased gradually 14 days after SAH, and returned to the normal ranges 31 days after SAH. When CSF pressure was below 200 mmH2O2 its increase was correlated slightly with an increase of CBF, while CBF was inclined to decrease with the increase of CSF pressure when it was over 200 mmH2O. In Grade IV patients, CBF and metabolism were disturbed in every period after SAH, and the prognosis was poor.