Cerebral vasospasm after subarachnoid hemorrhage, and inhibitory effect of nicardipine investigated by means of transcranial Doppler ultrasonography]

Cerebral vasospasm is a major complication associated with subarachnoid hemorrhage (SAH). However, real-time evaluation of vasospasm is very difficult via angiography, CT scan, and cerebral blood flow. In this study, for the evaluation of the arterial narrowing, the flow velocity in the middle cerebral artery (MCAFV) was measured with transcranial Doppler ultrasonography (TCD) in 41 patients with ruptured cerebral aneurysms which were repaired surgically within 48 hours after SAH. MCAFV was measured daily until the 25th day after onset. All patients underwent CT scan, angiography, and neurological assessments upon admission. To clarify the morphological changes of the cerebral vessels due to SAH, angiography was performed again about 10 days after surgery. For evaluation of the efficacy of treatment for vasospasm, 21 out of 41 cases were administered a calcium antagonist (4mg of nicardipine) through the cisternal drain every 12 hours for an average of 10 days. The other 20 cases did not receive nicardipine and served as controls. 15 patients with clinical symptoms had a rapid increase in MCAFV from the 3rd to 6th day after onset, and a high velocity of more than 150cm/sec continued for 7.6 +/- 3.6 days on the average. In marked contrast, 26 patients without clinical symptoms showed only a small increase in MCAFV of less than 110cm/sec. There was a significant correlation between the arterial narrowing of MCA and MCAFV (gamma = 0.72, p less than 0.01) except for 5 cases (12%).(ABSTRACT TRUNCATED AT 250 WORDS)