Abstract
Management for treatment of subarachnoid hemorrhage in acute stage is still controversial. One of the most important factors in the acute stage is chronic vasospasm. There are many different theories about the pathogenesis and treatment of chronic vasospasm.
Recently we can prospect the occurrence of the symptomatic vasospasm by CT findings. Therefore we evaluate the effect of intrathecal use of alpha-tocopherol to prevent the symptomatic vasospasm on these cases.
Alpha-tocopherol (50-100 mg) were injected into subarachnoid space in 23 cases, including 15 cases with early operation and 8 cases with delayed operation. In cases with early operation, cisternal drainage was put into parachiasmatic cistern, and 100 mg of alpha-tocopherol was injected via the drainage tube every day for 2 weeks. In cases with delayed operation 100 mg of alpha-tocopherol was injected via spinal tap or ventricular drainage if CT revealed hydrocephalus. Occurrence of symptomatic vasospasm was evaluated in these 23 cases compared with that in cases without use of alpha-tocopherol as a control.
Occurrence of symptomatic vasospasm in control group was 3% in gr 0, 7% in 1, 4% in gr 2, 45% in gr 4, 83% in gr 4. However, occurrence of symptomatic vasospasm in cases used alpha-tocopherol was 0% in gr 0 and 1, 11% in gr 2, 20% in gr 3, 40% in gr 4.
Therefore, symptomatic vasospasm cccurred almost half in cases used alpha-tocopherol compared with control group.
