Vasospasm assessed by angiography and computerized tomography

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Abstract
In 44 cases of ruptured cerebral aneurysm, vasospasm was demonstrated pre- or postoperatively. These cases were examined by bilateral carotid angiography and computerized tomography (CT), and the relationship between the angiographically visualized distribution of vasospasm, the neurological symptoms and infarction seen on CT was evaluated. Vasospasm occurred in only some intracranial portions of the cerebral arteries that were immersed in blood-stained cerebrospinal fluid. Angiographically, diffuse vasospasm extensively involving bilateral carotid systems indicated the gravest prognosis for patients. Vasospasm affecting 1 carotid system and the anterior cerebral arteries on the opposite side often produced permanent neurological deficits. When vasospasm was restricted to 1 carotid system or to bilateral anterior cerebral arteries, it was usually associated with temporary neurological symptoms; but it always produced residual neurological symptoms if it extended to the ascending branches (M3) of the middle cerebral arteries. CT demonstrated a low-density area or infarction in the territory of the spastic arteries in 25 (71%) of 35 cases with vasospasm. A low-density area was always detected when vasospasm occurred in M3 segments.