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.     

Electroencephalogram study of 52 cases following subarachnoid hemorrhage (author's transl)

During the past nine years the authors have seen 140 cases of ruptured intracranial aneurysm. In order to assess the EEG abnormalities in the chronic period after SAH, 45 patients were examined with 108 serial EEG recordings. Cases of early death were excluded from this study. Seven cases of SAH of unknown origin were also examined as a control group. Range of age was from 28 to 79 years. All of these patients except one were able to return to their previous activities. Results and conclusion were as follows. (1) The period of EEG study varied from a few weeks to nine years after SAH with the average being ten months. (2) The overall incidence of abnormal EEG was 82.4% in Group A (aneurysm) and 83.3% in Group B (unknown origin). (3) EEG abnormalities were divided into two patterns: focal slow wave (sporadic, polymorphous theta and delta wave) and focal spike, located mainly in the frontal and/or temporal areas. (4) Symptomatic epilepsy occurred in 6 cases of this series (13.3%) with onset from 8 months to 3 1/2 years after SAH. (5) Recent papers on microsurgical treatment of intracranial aneurysms have reported excellent results. Few studies, however, have dealt with EEG in the chronic period after SAH. The importance of EEG in the follow-up study of SAH is stressed because of the high incidence and long persistence of EEG abnormalities and because of the occurrence of epilepsy after SAH.     

Lumbo-omental shunt for drainage of cerebrospinal fluid in hydrocephalus

Summary A new cerebrospinal fluid (CSF) shunting procedure is presented. By transposing a pedicle graft of the greater omentum to the lumbar CSF compartment, the CSF absorption capacity of the omentum is utilized. The operation is applicable to the treatment of communicating hydrocephalus. The technical problems and physiological effects of the operation have been studied earlier in dogs. This paper presents the first case of an intended clinical series. The patient was studied for 18 months postoperatively by different examinations, including psychometric tests, cisternography, computer tomography, echo-ventriculography, and carotid angiography with measurement of the cerebral blood flow. A gradual improvement in his clinical state was registered after the operation.     

Density of cerebrospinal fluid and local anesthetics (author's transl)

The densities of cerebrospinal fluid and of local anesthetics, applicable to isobaric spinal anesthesia, were determined by using the Digital Density Meter DMA 02. The density of CSF showed little variation and at 37 degrees C was 1.00021 +/- 0.00024 g/cm3 (mean +/- SD, n = 22). The density of the local anesthetics bupivacaine 0.5%, carticaine 2%, lidocaine 2%, mepivacaine 2% and prilocaine 2% varied at 25 degrees C between 1.001 and 1.005 g/cm3, at 37 degrees C between 0.997 and 1.001 g/cm3. Tetracaine 0.5% in CBF increased its density by 0.00046 g/cm3. The addition of the vasoconstrictors adrenaline and ornipressine (POR 8) increased the density of the local anesthetic solutions insignificantly. On the basis of the narrow range of variation of CSF density, reliable statements may be made on the density dependent spread of local anesthetics in spinal anesthesia.     

Relationship between shunt-dependent hydrocephalus after subarachnoid haemorrhage and duration of cerebrospinal fluid drainage

Subarachnoid haemorrhage (SAH) patients in Fisher group 3 have a high risk of vasospasm and chronic hydrocephalus. We have provided cisternal irrigation combined with a head-shaking method for preventing vasospasm in SAH patients. We investigated 76 SAH patients in Fisher group 3 who received cisternal irrigation with head-shaking to evaluate the relationship between the occurrence of hydrocephalus and various clinical factors, including duration of cerebrospinal fluid (CSF) drainage. Chronic hydrocephalus occurred in 25 patients (33%). The occurrence of hydrocephalus was associated with longer duration of CSF drainage (median, 13 days versus 9 days). By logistic regression analysis using significant factors, including age, preoperative neurological grade and Glasgow Outcome Scale, only the duration of drainage was independently associated with the occurrence of hydrocephalus (Odds ratio = 1.18 per day; 95% confidence interval, 1.02- 1.36). These results indicate that long duration of CSF drainage for preventing vasospasm may increase the occurrence of hydrocephalus.     

Three cases of chronic subdural hematoma developing after direct aneurysmal surgery (author's transl)

Three cases of chronic subdural hematoma developing after direct aneurysmal surgery were presented. All patients were males and heavy drinkers. There was no history of head injury after craniotomy. In two of the three cases, the angiography was performed on the 12th postoperative day. An avascular area was already revealed on the postoperative angiograms, but there were no disorders at that time. The intervals between the aneurysmal surgery and the onset of symptoms of chronic subdural hematoma ranged from about two to three months. In this report, the diagnostic criteria for the chronic subdural hematoma resulted from intracranial surgery were also discussed with a consideration on the pathogenesis of this condition.