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The relationship between lipid peroxidation products and the severity of arterial spasm was studied in 86 patients. For this, the level of radical production, the content of the end lipid peroxidation product malonic dialdehyde and the overall antioxidative activity of lumbar cerebrospinal fluid were determined during 24-hour Doppler monitoring of blood flow in the middle cerebral and internal carotid arteries. Following subarachnoidal hemorrhage, the activation of lipid peroxidation processes was shown to correlate with the severity of arterial spasm and it is likely to contribute to the development of late ischemias. Nimotop used to treat patients with significant arterial spasm caused a reduction in the rate of free radical lipid peroxidation to that characteristic for patients with moderate spasm. The findings suggest that it is expedient of including antioxidants into the combined therapy of patients with acute subarachnoidal hemorrhage.

The clinical status, angiographic and Doppler ultrasound transcranial findings were compared in 50 patients with acute subarachnoidal hemorrhage (40 with aneurysmal hemorrhage and 10 with unknown hemorrhage). There was a correlation between the change in the linear velocity of blood flow in the cerebral arteries and the clinical manifestations of arterial spasm-induced brain ischemia. With this, Doppler signs of arterial spasm appeared as clinical manifestations 3-4 days earlier. The linear velocity of middle cerebral arterial blood flow, which is critical for the development of ischemic complications of arterial spasm was 295 +/- 6 cm/sec. The magnitude and duration of the excess critical level of the linear velocity of blood flow and the presence of arterial spasm in the contralateral hemisphere may determine whether the progressive ischemic symptoms are reversible or irreversible. A further course of arterial spasm, development of ischemic complications and their outcomes may be predicted by the increasing gradient of the linear velocity in the cerebral arteries at days 4-6 of subarachnoidal hemorrhage and the extent of spasm.

The paper deals with the specific features of using Doppler transcranial sonography in patients with subarachnoid hemorrhage. It describes the advantages and disadvantages of the method for the diagnosis of arterial spasm of various intracranial arteries. A comparison of angiographic and Doppler sonographic findings revealed that the values of the peak systolic velocity of blood flow (r = -0.875, p < 0.0001) are the most informative for the diagnosis of the extent of intracranial arterial lumenal narrowing. Patients with aneurysm ruptures in the internal carotid and middle cerebral arteries were found to have a pronounced increase in the blood flow velocity at the site of aneurysm. The intracranial arterial blood flow parameters critical for the development of brain ischemia during cerebral arterial spasm after subarachnoid hemorrhage are specified in the paper.

Clinical and neuropsychological examinations were made in 33 patients with post-bleeding hydrocephalus. The neuropsychological syndrome in aresorptive hydrocephalus due to ruptures both of arterial aneurysms and of arteriovenous malformations was shown to appear as dysfunction of frontal and diencephalic regions of the brain. It included disorientation, inertness, spontaneity, perseveration, awakening fluctuations, persistent memory dysfunctions and sluggish mentality. Neuropsychological symptoms were greatly dynamic. The level of awakening and orientation underwent rapid changes. The syndrome showed more frequently a milder regressive course in aresorptive hydrocephalus caused by ruptures of arteriovenous malformations than by those of arterial aneurysms; asymptomatic cerebral ventricular dilation being observed.

It was established from study of lipid peroxidation (LOP) products in 19 patients (16 with subarachnoid hemorrhages /SAH/ resulting from rupture of arterial aneurysms and 3 with arterial hemorrhages in the "cold" period) that their content was significantly higher in patients with a history of 2 or 3 SAH than in those who had suffered from a single SAH. The LOP level in the c.s.f. in patients of both groups differed significantly from that in the c.s.f. of patients without SAH. It was also established that the content of LOP products in patients with an unfavourable outcome of the disease was more than twice that in patients with a favourable course and outcome of the disease. Administration of antioxidants (alpha-tocopherol and ascorbic acid) inhibited the LPO processes, which was manifested by a decrease of the content of malonyl dialdehyde in the c.s.f.

Experience in microsurgical treatment of 23 patients with aneurysms of the vertebrobasilar bed at the Institute of Neurosurgery, AMS USSR, is discussed. Some aspects of surgical approaches and the method of removal of the aneurysms are described. Particular attention is focussed on complicated surgical situations which needed non-standard solutions (division of the A1 segment of the anterior cerebral artery and the posterior communicating artery). All patients were operated on in the "cold" period after spontaneous intracranial hemorrhages. The postoperative mortality (one patient) is analysed.

On the basis of analysis of 83 cases with multiple arterial aneurysms of the brain, the authors arrived at the following conclusions. The frequency of their recognition is 10.3% and is directly dependent on the completeness and thoroughness of the angiographic examination. Recurrent hemorrhages in multiple aneurysms occur mostly from one and the same aneurysm (85.3%) and in rare cases form different aneurysms (14.7%). With the use of a diagnostic complex (cerebral angiography, EEG, CT, careful study of the medical history and the clinical picture of the disease) the aneurysm which is the source of the intracranial bleeding can be identified in most cases (93%), which is important in planning the tactics of surgical treatment. Exclusion of all aneurysms, in one stage if possible, is the main principle of surgical management of multiple aneurysms. The aneurysm which caused the intracranial bleeding should be excluded first. The development of surgical approaches to the aneurysms and the use of microsurgery made it possible to achieve definite successes in surgery of multiple aneurysms. Postoperative lethality was 2.7%. Most of the patients (84.7%) are capable of working or are adapted to every-day life.