抄録
Although hemorrhagic infarction has been reported in many publications, little has been known about its occurrence following cerebral vasospasm. The authors have experienced 6 cases of hemorrhagic infarction after vasospasm, 3 cases which had received induced hypertension therapy for the improvement of the cerebral ischemia. In this study we presented the clinical characteristics and significances of the hemorrhagic infarction with special emphasis to its prevention.
Among 100 patients suffering from subarachnoid hemorrhage who admitted to the Kyoto University hospital from January 1980 to December 1981, 33 cases (33%) presented symptomatic vasospasm and were analized in this study. Dopamine-or isoproterenol-induced hypertension therapy was performed in 14 cases out of 33. Six cases developed insidious onset of consciousness disturbance 17.0±2.9 days after subarachnoid hemorrhage and 8.5±3.3 days after the onset of vasospasm. Computed Tomography revealed subcortical high density areas surrounded by low density areas. Multiple lesions were noted in 4 cases. Although mild or moderate degree of aggravation in consciousness was observed in all of 6 cases after the hemorrhagic infarction, none died of it. Systemic blood pressure was documented to increase concomitantly with the occurrence of hemorrhagic infarction in 3 cases, two of which had been treated with induced hypertension therapy. Blood pressure was found to increase by an averaged value of 24%after the completion of induced hypertension in 7 cases out of 14, although its etiology could not be clarified.
Clinical characteristics of the hemorrhagic infarction are considered to be as follows: it is likely to occur in aged patients with ruptured aneurysms located in the area of the anterior cerebral artery whose systemic blood pressure increase after the improvement of vasospasm.
The hemorrhagic infarction is supposed to attribute to relaxation of spastic arterial wall, which is analogous to the recanalization phenomenon of embolic occlusion.
In conclusion it is very important for the prevention of the hemorrhagic infarction following vasospasm to manage the systemic arterial pressure not only during induced hypertension therapy but also within a week after that.
