Regional cerebral blood flow in patients with ruptured intracranial aneurysms

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✓ Eighty-five studies of regional cerebral blood flow (rCBF) were performed on 49 patients with ruptured intracranial aneurysms. The changes in rCBF were analyzed under various pathophysiological conditions. The degree of flow abnormalities correlated well with the clinical severity of neurological deficits. All of the patients with diffuse vasospasm of severe grade, to less than half of their control value, showed focal areas of decreased flow below 30 ml/100 gm/min, in addition to a reduction in mean CBF. The relief or disappearance of vasospasm in angiograms was followed by the increase of rCBF in the ischemic focus and mean CBF. Marked reduction in rCBF was found in patients with intracerebral hematoma and ventricular dilatation. Impaired CO2 response and autoregulation were found in patients with severe neurological deficits, a severe degree of vasospasm and marked depression of mean CBF. In this series direct operation was delayed in patients with impaired vascular reactivity as well as marked decrease of mean CBF below 30 ml/100 gm/min; good clinical results were obtained in these patients.

Article Information

Address reprint requests to: Ryoji Ishii, M.D., Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata City, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Relationship between cerebral blood flow (CBF) and clinical grade (Hunt and Hess classification). Open circles indicate the values of mean CBF. Bars represent the values of rCBF in the ischemic foci. Open circles without a bar indicate cases with no ischemic focus. The cases with hydrocephalus are shown by asterisks.

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    Relationship of occurrence of focal ischemia, mean cerebral blood flow (CBF), and angiospasm in patients in whom regional CBF measurements were performed within 30 days after the onset, and intracerebral hematomas were not found on computerized tomography. The types of angiospasm are indicated as follows: dotted circle = diffuse-severe type, black circle = diffuse-mild type, white circle = peripheral type, triangle = multi-local type, square = local type, cross = no angiospasm.

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    Relationship between cerebral blood flow (CBF) and angiospasm, in the patients with ischemic foci shown in Fig. 2. The symbols of mean CBF and regional CBF in the ischemic foci, and of the type of angiospasm are as defined in Figs. 1 and 2.

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    Relationships between cerebral blood flow (CBF), the existence of a low-density area on computerized tomography (CT), and angiospasm, in the patients shown in Fig. 2. Symbols are as defined in Figs. 1 and 2.

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    Changes in mean cerebral blood flow (CBF) for each patient with angiospasm, in whom regional CBF measurements were performed more than twice. The relief from angiospasm was followed by the increase of regional CBF in the ischemic focus and mean CBF. The values of mean CBF are indicated by the symbols. P indicates the case with angiospasm of peripheral type.

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    Relationship between cerebral blood flow (CBF) and intracerebral hematoma. The symbols are defined in Fig. 1. Whether intracerebral hematoma is seen on computerized tomography or has been removed or absorbed is indicated by + or −.

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