Diagnosis and treatment of factors complicating subarachnoid hemorrhage

Regional cerebral blood flow (rCBF) measurements in the steady state and after activation techniques were combined with serial cerebral arteriography in patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm. Such information was useful in selecting and evaluating the effectiveness of treatment for complicating factors such as cerebral vasospasm, cerebral edema, acute and chronic hydrocephalus and intracerebral hematoma. Regional cerebral blood flow values were found to be reduced in patients after SAH and correlated well with the neurological status and the complicating factors listed above. When vasospasm was relieved by phenoxybenzamine (PBZ), rCBF did not increase although regional cerebral blood volume did, suggesting that other factors may be more important for the reduction of rCBF such as cerebral edema and communicating hydrocephalus. When cerebral edema and acute hydrocephalus were treated by either intravenous glycerol or lumbar cerebrospinal fluid drainage, RCBF increased.