Abstract
The fibrinolytic activity of cerebrospinal fluid has been studied in 60 cases with subarachnoid hemorrhage by Astrup's biochemical method. In 26 cases of them the fibrinolytic activity of CSF has been measured repeatedly during early stage of subarachnoid hemorrhage. It increased especially in the first one week after subarachnoid hemorrhage in all cases, and decreased gradually when the rebleeding of reptured aneurysm did not take place. On the other hand, increased fibrinolytic activity of CSF was detected repeatedly or gradually when rebleeding occured afterward. These results suggested the relationship between rebleeding of ruptured aneurysm and increased fibrinolytic activity of CSF.
The authers forcasted the rebleeding of subarachnoid hemorrhage and determined the best time of operation by monitoring of fibrinolytic activity in CSF. Compared with alteration of fibrinolytic activity of CSF, the fibrinolytic activity of serum was normal continuously after subarachnoid hemorrhage. It has been suggested that local fibrinolysis would cause rebleeding of ruptured aneurysm.
Fibrin-fibrinogen degradation products (FDP) was increased in CSF with subarachnoid hemorrhage. FDP, D fraction was detected in bloody CSF, but FDP, X, Y, and E fractions were not detected in CSF with subarachnoid hemorrhage immunologically. This result also suggested increased local fibrinolysis.
Localization of fibrinolytic activity in tissue has been studied in 9 aneurysms and 5 arterio-venous malformation by Todd's fibrin slide technique and immunofluorence study. Increased activity was seen in adventitia and endothelium of ruptured aneurysm, arachnoid menbrane, area of brain softening and wall of vessels of arterio-venous malformation. Increased fibrinolytic activity in CSF with subarachnoid hemorrhage must be released from these structures. The authors emphasized the important role of local fibrinolytic activity on rebleeding of ruptured aneurysm.
