Vasospasm is one of the most important factors to treat the subarachnoid hemorrhage. If we can predict the occurrance of vasospasm, the prognosis will be made clear on acute stage, and the management of subarachnoid hemorrhage will be clearer.
CT revealed the location and volume of the hematoma. The purpose of this paper is clarify the occurrence of vasospasm from the view point of CT findings and neurological grading, and then to evaluate the timing of surgery.
281 cases of aneurysmal surgery were carried out in our hospital from September 1976 to March 1981. 155 cases of grade I-IV of Hunt and Hess grading, who were operated on by the same neurosurgeon, were made on object of this study.
(Method) Hematoma in the basal cistern was classified into 5 degree with reference to the location and volume of the hematoma in the basal cistern and Hounsfield number. The disappearance of hematoma from basal cistern was examined following by CT day by day. The relation between vasospasm and hematoma in the basal cistern compared with neurological grading were evaluated. Then timing of the operation were studied.
(Results) Hematoma in grade 1 and 2 disappeared from the basal cistern within 4 days, however hematoma in grade 3 and 4 remained over a week. The occurrence of vasospasm was more related to the grade of hematoma in the basal cistern than neurological grade of Hunt and Hess.
Vasospasm occurred less in cases with early operation within 24 hours after onset than in cases with later operation after 24 hours.
