ABSTRACT

Objectives

Radiological and clinical cerebral vasospasm (CV) is defined either as a delayed narrowing of cerebral arteries after aneurysmal subarachnoid hemorrhage (aSAH) or/and occurrence of new neurological deficit/worsening of Modified Glasgow coma score for 2 or more points. The objective of this study is to determine the presence and correlation between clinical and radiological presence of vasospasm in patients with aSAH.

Methods

This study was designed as a clinical, prospective single center study at the Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia. A total of 50 patients was included in the study after having radiologically confirmed aSAH. Intensity and region of CV was determined by CT and CTA performed both on admission and on day 9 of hospitalization, except for cases where clinical protocol required earlier imaging due to occurrence of clinical signs and symptoms of CV. In all patients, values of arterial blood pressure (PABP), headache (HA), body temperature (PBT), nonspecific behaviors (NSB), deterioration of consciousness (DC), new neurological deficit (NND), deterioration of two points or more per modified Glasgow Coma Scale (DmGCS ≥ 2) were monitored.

Results

CTA showed angiographic vasospasm detected in 100% patients with aSAH. Statistically significant positive correlation was found between the intensity of radiological CV and appearance of NND and DmGCS ≥ 2.

Conclusions

This study confirms that CV always follows aSAH. Future research into pathophysiology of CV is needed in order to determine exact treatment strategies and targets so treatment towards zero mortality can be achieved.

中文翻译：

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动脉瘤性蛛网膜下腔出血后放射学与临床脑血管痉挛的比较：血管痉挛总是存在吗？

摘要

目标

放射学和临床脑血管痉挛 (CV) 被定义为动脉瘤性蛛网膜下腔出血 (aSAH) 后脑动脉延迟狭窄或/和出现新的神经功能缺损/改良格拉斯哥昏迷评分恶化 2 分或更多。本研究的目的是确定 aSAH 患者血管痉挛的临床和放射学存在及其相关性。

方法

本研究是在塞尔维亚诺维萨德伏伊伏丁那临床中心神经外科诊所设计的一项临床、前瞻性单中心研究。在放射学证实 aSAH 后，共有 50 名患者被纳入研究。CV 的强度和区域由入院和住院第 9 天的 CT 和 CTA 确定，但由于出现 CV 的临床体征和症状而临床方案需要早期成像的情况除外。所有患者的动脉血压值（PABP）、头痛（HA）、体温（PBT）、非特异性行为（NSB）、意识恶化（DC）、新的神经功能缺损（NND）、恶化两点或更多监测根据改良格拉斯哥昏迷量表 (DmGCS ≥ 2)。

结果

CTA 显示在 100% 的 aSAH 患者中检测到血管造影血管痉挛。在放射学 CV 强度与 NND 的出现和 DmGCS ≥ 2 之间发现统计学上显着的正相关。

结论

该研究证实，CV 始终遵循 aSAH。未来需要对 CV 的病理生理学进行研究，以确定准确的治疗策略和目标，从而实现零死亡率的治疗。