Control of Hypertension and Prophylaxis against Vasospasm in Cases of Subarachnoid Hemorrhage: A Preliminary Report

Abstract

Thirty hypertensive patients with subarachnoid hemorrhage were divided randomly into two groups. The treated group was begun on preliminary volume expansion, and control of hypertension was carried out using vasodilators and centrally acting drugs. The control group was treated in the classical manner for hypertension, with a diuretic as the foundation for therapy. The incidence of clinical vasospasm was compared to that of angiographic spasm. The incidence of preoperative vasospasm in the treated group was 20%, as compared to 60% in the untreated group (P less than 0.01). Of the treated group, 87% survived to operation, whereas only 53% of the control group survived to operation (P less than 0.01).

Definition of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage as an Outcome Event in Clinical Trials and Observational Studies

“…Because of its delayed onset, this complication is often called delayed cerebral ischemia (DCI). 2,4 Besides the term "DCI," many other terms are used in the literature to describe this clinical phenomenon, such as delayed ischemic neurological deficit, [5][6][7] delayed ischemic deficit, 8,9 delayed neurological deficit, 10,11 secondary cerebral ischemia, 12,13 vasospasm, 14,15 clinical vasospasm, 16,17 symptomatic vasospasm, 18,19 symptomatic ischemia, 20 and cerebral infarction. 21 The use of so many different terms is problematic, not only because many studies provide incomplete definitions of the terms used, if at all, 22,23 but also because a variety of definitions are used for the same term.…”

Routine Management of Volume Status After Aneurysmal Subarachnoid Hemorrhage

“…Eleven original studies dealing with prophylactic hypervolemic therapy after aneurysmal SAH were identified: four randomized controlled trials (RCTs), two prospective interventional trials, and five observational series using historic controls (Table 1) [2][3][4][7][8][9][10][11][12][13][14]. Together, the RCTs included 244 patients; data from another 531 patients were investigated in the remaining studies.…”

“…Rosenwasser and colleagues [7] investigated 30 patients after aneurysmal SAH grade I to IV on the Hunt-Hess scale, divided randomly in two groups. The treatment group received a pulmonary artery catheter and volume loading with albumin up to a pulmonary capillary wedge pressure (PCWP) of 12-15 mm Hg; this group also received a complex medication regimen, including hydralazine, methyldopa, propranolol, and nitroprusside to keep the systolic blood pressure below 120 mm Hg.…”

A Computational Simulation of the Effect of Hemodilution on Oxygen Transport in Middle Cerebral Artery Vasospasm

“…Therapeutic manipulation of hemodynamics and blood rheology for the supportive management of vasospasm was first described 30 years ago (Kosnik and Hunt, 1976;Rosenwasser et al, 1983). The combination of induced hypertension, hypervolemia, and hemodilution (HHH) therapy is widely used for prophylaxis and therapy in the setting of angiographic or clinical vasospasm (Brisman et al, 2006;Mayberg et al, 1994;Sakowitz et al, 2006).…”

“…The hemodilution aspect of HHH therapy continues to be controversial (Awad et al, 1987;Ekelund et al, 2002;Hassan et al, 2004;Kosnik and Hunt, 1976;Muench et al, 2007;Naidech et al, 2007;Rosengart et al, 2007;Rosenwasser et al, 1983;Treggiari et al, 2003). In spite of this, it is practiced 30% to 60% of the time (Meyer et al, 2011;Sakowitz et al, 2006).…”