Prevention and Treatment of Delayed Ischaemic Dysfunction in Patients with Subarachnoid Haemorrhage: An Update (Acta Neurochirurgica Supplement (45))

During the last meeting of the European Association of Neurosurgical Societies (Barcelona 7-16 September 1987), a Symposium was devoted to the use of calcium antagonists in cerebral vasospasm. As shown by its title "Prevention and treatment of delayed ischaemic dysfunction in patients with subarachnoid haemorrhage: an update", papers presented at the Symposium covered a broad spectrum from some basic data on pathophysiology of subarachnoid haemorrhage (SAH) and delayed ischaemic dysfunction, to the clinical use of nimodipine, which has been largely documented among calcium inhibitors for its cerebrovascular properties. This supplementum of Acta Neurochirurgica is based upon the papers presented. Some articles, however, have been extended to take into account further results in order to present a broad view of the subject. The Symposium started with two presentations concerning general aspects of SAH: in the first one, B. Voldby reviewed the pathophysiological events following SAH: if modifications of intracranial pressure (ICP) and decrease of cerebral blood flow (CBF) are the primary alterations, metabolic changes (particularly reduction in CMR0 ) 2 contribute rapidly to disturbances of brain circulation. A variety of mechanisms may be responsible for the neurological dysfunction: most of them are directly related to the reduction in cerebral perfusion pressure (CPP) which may result in ischaemia. This fall in CPP (either due to elevation of ICP or reduction of mean arterial blood pressure) is observed under different pathophysiological conditions, discussed in the paper by A. D. Mendelow. The papers presented in this supplement volume of Acta Neurochirugica cover a broad spectrum from basic data on the pathophysiology of Subarachnoid Haemorrhage (SAH) and delayed ischaemic dysfunction to the clinical use of Nimodipine which has been largely documented among calcium inhibitors for its cerebro-vascular properties. The first two presentations deal with the pathophysiological events following SAH and discuss a variety of mechanisms which may be responsible for the neurological dysfunction. The second part discusses the cerebro-vascular and direct cerebral effects of Nimodipine and its evaluation by transcranial Doppler sonography and the interactions of this drug with general anaesthesia. Therapeutic aspects constitute the third part of this volume. On the basis of present knowledge and experience it seems that early surgery combined with prophylactic treatment represents the best option for patients after aneurysmal rupture Front Matter....Pages I-VII Pathophysiology of Subarachnoid Haemorrhage....Pages 1-6 Pathophysiology of Delayed Ischaemic Dysfunction After Subarachnoid Haemorrhage: Experimental and Clinical Data....Pages 7-10 Cerebrovascular and Cerebral Effects of Nimodipine — an Update....Pages 11-20 Haemodynamic Effectiveness of Nimodipine on Spastic Brain Vessels After Subarachnoid Haemorrhage Evaluated by the Transcranial Doppler Method....Pages 21-28 Interactions Between Nimodipine and General Anaesthesia — Clinical Investigations in 124 Patients During Neurosurgical Operations....Pages 29-35 Attempts at Prevention and Treatment of Delayed Ischaemic Dysfunction in Patients with Subarachnoid Haemorrhage....Pages 36-40 Nimodipine in the Prevention of Ischaemic Deficits After Aneurysmal Subarachnoid Haemorrhage....Pages 41-50 Review of Treatment of Symptomatic Cerebral Vasospasm with Nimodipine....Pages 51-55 The papers presented in this supplement volume of "Acta Neurochirugica" cover a broad spectrum of topics, from basic data on the pathophysiology of Subarachnoid Haemorrhage (SAH) and delayed ischaemic dysfunction to the clinical use of Nimodipine.