[Ischemic cerebral symptoms after subarachnoid hemorrhage due to aneurysmal rupture (author's transl)]

Abstract

Among 169 patients treated at our clinic during past six years there were twenty-four cases (14 per cent) in which cerebral ischemic symptoms gradually developed after full recovery from SAH due to aneurysmal rupture. Duration form the aneurysmal rupture to the onset of ischemic symptoms varied from four days to fourteen days (8 days on average). As the initial symptoms hemiparesis and disturbance of consciousness (18 and 14, respectively) were two major symptoms, and those who showed disturbance of consciousness had more grave prognosis than those with hemiparesis. There were no correlations between the initial symptoms and the sites of aneurysm, but the ICA cases had definitely poor prognosis among those who developed ischemic signs after SAH. Those who became symptomatic within 7 days after SAH had poorer prognosis than those who showed initial symptom more than 8 days after SAH. On angiograms which were done shortly after the onset of symptoms, severe and extensive vasospasm was noted in all cases but four in which degree of vasospasm was not so severe and extensive. Operative treatment, when done within 5 days after the onset of ischemic symptoms had poorer results than when done over 6 days. As a conclusion, it is necessary to watch for possible onset of ischemic symptoms, especially in ICA patients, when seen later than four days after SAH. If ischemic symptoms were present and progressive, the operative treatment should be postponed until clinical course turns uphill by intensive treatments.