[Cerebral vasospasm after subarachnoid hemorrhage].

Cerebral vasospasm causes permanent neurolological deficit or death occurance in 13% of clinical cases. Peak frequency is from 8-10th day after SAH. The purpose of this study is factor analysis that may have influence on vasospasm development , as well as predictor determination. The study is prospective and analysis 192 patients treated in Institute of Neurosurgery, Clinical Centre of Serbia, Belgrade. The majority of patients were admitted in hospital in first four days after SAH, and 184 had GCS over 7. Univariate methods of factor analysis were used, and for significance of predictors influence testing multivariante regression analysis was used. Vasospasm occurred in 22,40% of all cases. No relationships have been found between sex, age, previous hypertension, timing of surgery, appearance of hydrocephalus and intracerebral hematoma, hypertermia or mean arterial blood pressure, with occurrence of cerebral vasospasm. Factors with significantly associated with the occurance of vasospasm were: hearth disease, hypernatriemia, Hct, clinical grade on admission as well as preoperative clinical grade and Fisher CT scan grade. In the first four days after SAH, Fisher scan grade, preoperative clinical grade and Hct, appeared as predictors. After four days, clinical grade on admission and hypernatiemia, showed as poredictors.

[Analysis of the therapeutic modalities when cerebral vasospasm occurs and the outcome of the treatment of patients with SAH].

Vasospasm is the principal cause of a poor outcome in patients with SAH. The aim of the study is to establish the effect of the therapeutic modalities on vasospasm, to establish morbidity and mortality of patients with SAH, as well as the causes of the poor outcome. The study is prospective and analyzes 192 patients treated at C ward of the INH KCS. Vasospasm incidence was 22.40%. Therapeutic modalities depended on prescribed quantities of colloid solutions and MgSO4 solution. Differences in the vasospasm incidence between the groups were not significant, the reason probably being that the maximal doses of colloid solutions were prescribed mostly to the higher graded patients. In patients who received MgSO4 vasospasm was less frequent, but not statistically significant (11.11% vs. 23.56%) Of 192 patients, 78.1% completely recovered, 9.9% had a certain degree of invalidity, and 12.0% did not survive. The most frequent cause of death was vasospasm (41.67%) and then general medical complications (20.93%).

[New trends in neuromonitoring patients with with aneurysmal subarachnoid haemorrhage].

Neurointensive care of patients with subarachnoid haemorrhage is based on the theory that clinical outcome is the consequence of the primary haemorrhage and a number of secondary insults in the acute post haemorrhage period. Several neuromonitoring techniques have been introduced or accomplished into clinical practice in the last decade with the purpose of monitoring different but related aspects of brain physiology, such as cerebral blood flow (CBF), pressure within the cranial cavity, metabolism, and oxygenation. The aim of these techniques is to obtain information that can improve knowledge on brain pathophysiology, and especially to detect secondary insults which may cause permanent neurological damage if undetected and untreated in "real time", at the time when they can still be managed. These techniques include intracranial pressure (ICP) measurements, jugular venous oxygen saturation, near-infrared spectroscopy, brain tissue monitoring, and transcranial Doppler. The available devices are limited because they measure a part of complex process indirectly. Expense, technical difficulties, invasiveness, limited spatial or temporal resolution and the lack of sensitivity add to the limitation of any individual monitor. These problems have been partially addressed by the combination of several monitors known as multimodality monitoring. In this review, we describe the most common neuromonitoring methods in patients with subarachnoidal hemorrhage that can assess nervous system function, cerebral haemodynamics and cerebral oxygenation.

[Difference between values of gas analysis of arteries and internal jugular vein in patients with cerebral infarction].

INTRODUCTION: Cerebral infarction is more and more frequently present by massive participation and high percentage of mortality even in young population. It is notified as very hard, vitally endangered disease. OBJECTIVE: To prove whether there is a difference in the gas analyses of the arterial and cerebral venous blood between the patients with the cerebral infarction of the left and right hemisphere and why it is significant for the treatment of those patients. MATERIAL AND METHODS: Sixty-five (65) patients of both sexes who were diagnosed by CT as: cerebral infarction, cerebral multiinfarctions and cerebral haemorrhagic infarctions were investigated. Under the same conditions their radial artery and left and right internal jugular vein were tapped--on the fourth, eighth and tenth day of their disease. Gas analysis, calculation of oxygen content and statistical comparison of testing results were performed from the samples of arterial and venous blood. RESULTS: By continuous monitoring of gas analysis parameters of arterial and cerebral venous blood from internal jugular vein, we can follow up the phases of disease, the velocity of changes of gas analysis parameters and adequacy of brain circulation and to correct therapy adequately for the purpose of preventing basic disease complications and to estimate the results of treatment. CONCLUSION: There is a significant difference between the results of gas analysis of arteries and the internal jugular vein, in patients with infarctions of the left and right hemisphere of the brain.