Traumatic Subarachnoid Hemorrhage And Vasospasm

Cerebral vasospasm (CVS) is the severe complication of traumaticsubarachnoid hemorrhage(TSAH) and one of important factors to decide theoutcome . Its etiopathogenisis ,diagnosis and treatment is the hot spot to clinicstudy. The aim of this study is to investigate the relation of the CVS followingTSAH with inflammation elicited by the inflammatory cytokines ,thehemorrhage volume accumulated in the subarachnoid and the degree of brailtrauma. Then to discuss the meaning of forepart diagnose earlier in the CVSfollowing TSAH by the inflammatory cytokine ,CT scanning and intracranialpressure. The result show us that CVS following TSAH is correlative with thecytokines such as IL-6 and TGF, the volume in the subarachnoidhemorrahge,and GCS while the patient admited. While earlier examining ofthe cytokines with CT scanning can help us to predict the CVS and provide theevidence to preventive medication.We choosed 50 cases definited TSAH by CT imaging or lumbar punctureduring the April to December in 2004 in the study. There are 39 female and 11male , age from 17 to 69 and average age is 44 .We assesed the degree of braininjury with Glawgow Coma Scale and CT imaging by the reformed Fishergrade. In this group 11 cases were consciousness, 24 cases were scaled 9 ～15and the 15 cases were 3～8. There are 5 cases was diagnosed by lumbarpuncture because we can not see the subarachniod hemorrhage in the first CTscanning. Moreover 11 cases were only with subarachnoid hemorrhage and 34cases were complicated the other brain injury. According to the reformedFisher grade there were 5 cases in grade Ⅰ,21 cases in grade Ⅱ, 24 cases ingrade Ⅲand no one in grade Ⅳ. All the patient were lumbar punctured tomeasure the intracranial pressure regularly and measure IL-6 and TGFin cerebrospinal fluid(CSF). At the same time we routinely examining thevessel by Transcranial Doppler to know the mean flow velocity of themiddle cerebral artery (VmMCA ) and internal carotid artery (VmICA). Wealso calculated the Lindergaard Index (VmMCA/VmICA) .We defined themild CVS as the VmMCA was 120～140cm/s ,middle CVS was 140～200cm/s and severe CVS was over 200cm/s. Finally we performed thestatistics analysis between these result and TCD. It showed us that therewere 22 cases suffered from CVS and incidence is 44%. In this group 11patient were diagnosed mild CVS,7 cases were middle CVS and 4 caseswere severe CVS ,meanwhile ischemic infarction was occurred in 2 cases and2cases were died. We know the more severe of the head injury of the morelower of GCS, the more high of incidence rate of CVS. Then it is the directratio between the reformed Fisher grade and the incidence of CVS. It is saidthat the incidence is increased accompany with the increased of the scaled ofreformed Fisher grade. But the incidence is decreased accompany with theincreased of GCS. All the cases were measured the ICP regularly .It said thatthe ICP w ere increased in both the CVS subset and the non-CVS subset.However the ICP in the CVS subset was higher than in the non-CVS subsetduring day 3～10 after head injury and more significant higher within day5～7. The ICP in both subset were decrease during day 10～14 afterinjury .We can find that VmMCA of CVS subset start to increase from day 3post-trauma and peaked on day 5～7 , then it began to decrease and becamethe normal degree during day 10～14. However VmMCA began to increase onday 7 after injury in 2 cases and the CVS could last 3 weeks. In the non-CVSsubset the VmMCA also gently increase after injury .It happened during day3～10 after injury and then to decrease gradually. The cytokines IL-6 and TGFin CSF were measured by radioimmunity and it increased and peaked on day 1after injury. It began to decrease evidently from day 7 after injury. Meanwhilecontrasted the CVS to non-CVS we know the it show significant differenceduring day 1～10 and it became no statistic difference on day 14. It indicatedthat inflammation elicited by inflammatory cytokines participated in theengendering of CVS and last the while course. 2 cases were died in thisgroup and also 2 cases ischemic infarction were happened caused by severeCVS. So we suggest that we can prognose the occurrence and degree of CVSby the CT imaging and cytokines measured earlier. It can also direct thetherapy. By this study we found that TSAH should be one of important factors toresult in CVS and it can aggravate the pathogenetic condition. Inflammationelicited by inflammatory cytokines is important reason for TSAH to result inCVS. It participates in the engendering of CVS and show its change in earlierperiod and it is better to guiding therapy. We can consider it as one ofindexesindices to forecast the CVS earlier. CVS is related to the brain injury degree or GCS .Its incidence rategradually increase following the severe of brain injury and the degree of CVSbecame more severe. Meanwhile it is related to the volume of subarachnoidhemorrhage.The rate of incidence increase by degrees accompanied with thevolume of subarachnoid hemorrhage and the middle and severe CVS casesalso advanced. Moreover the CVS also concerned with the location of...