Vasoconstrictor activity in cerebrospinal fluid from patients subjected to early surgery for ruptured intracranial aneurysms

Abstract

Vasoconstrictor activity was examined in serial samples of CSF obtained from 10 patients undergoing aneurysm clipping within 48 h after subarachnoid hemorrhage. There was no close relationship between vasoconstrictor activity in postoperative CSF samples and the patient''s clinical condition or angiographic vasospasm. The identity of the vasoconstrictor substance(s) in CSF was not established, but serotonin, histamine, norepinephrine, epinephrine, acetylcholine or angiotensinII were eliminated as prime vasoconstrictor agents inducing cerebral vasospasm. Differences in the temporal profile of the responses of isolated tissues to CSF from patients with early and late surgery suggested that differing substances were involved in the production of spasm. A correlation between CSF K+ concentrations and vasoactive substances was found, but K+ could not account for vasoconstrictor activity of CSF. A log:linear correlation between total vasoconstrictor activity and total CSF collected could not be explained. Because of possible differences in the identity of vasoactive substances in CSF in this study compared to earlier studies, clinical comparisons based on apparent differences in pharmacological potency of CSF were not warranted. Removal of subarachnoid blood by cisternal rinsing seemed to be a useful surgical adjunct.