Ruptured Intracranial Aneurysms—The Role of Arterial Spasm

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In a recent paper the authors1 discussed the findings of postoperative angiography carried out routinely on patients with ruptured intracranial aneurysms. It was felt that arterial spasm was one of the chief reasons for postoperative morbidity and mortality, and in this paper the problem is considered further with regard to cause and effect. Attention is given also to earlier manifestations of arterial spasm, whether operation was undertaken or not.

It has been suggested that vasospasm is an optical illusion. However, when a vessel, previously shown to be of normal calibre, later appears thread-like in two or

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Figures

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    Lateral and anteroposterior view of arterial phase of angiogram before operation.

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    Radiographs in same case as in Fig. 1, 7 days after clipping of posterior communicating aneurysm, showing intense spasm of distal portion of carotid siphon and its branches.

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    (a) First radiograph of lateral series of angiogram under Fluothane anaesthesia.

    (b) Corresponding first radiograph after 20 min of hyperventilation.

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    (c) Second radiograph in same series as 3b. Contrast is dammed back with narrowing of distal portion of carotid siphon and its branches. (d) First radiograph in series after restoration of blood pCO2 to same level as in 3a, showing arteries have returned to their original calibre.

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    (a) First radiograph in lateral series after anaesthesia with Demerol. (b) Corresponding first radiograph after 20 min. of hyperventilation, showing same effect as in Fig. 3.

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