Article
Vasospasm after aneurysmal subarachnoid hemorrhage in the elderly: Less frequent, less dangerous?
Vasospasmus nach aneurysmatischer Subarachnoidalblutung beim älteren Patienten: seltener und harmloser?
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Published: | April 23, 2004 |
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Outline
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Objective
There are still conflicting data whether the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is related to the age of the patient or not. One the one hand, reduced reagibility of the vessel wall to vasoactive substances was shown with increasing age, one the other hand, angiographic studies failed to demonstrate a reduced vasospasm incidence in aged patients. Thus, it was the objective of the study to investigate the possible role of age on the incidence of cerebral vasospasm.
Methods
725 patients with acute SAH, radiologically proven aneurysm, and operation entered the data base. Transcranial Doppler sonography (TCD) for vasospasm detection was performed daily, blood flow velocities of >120 cm/s were considered to indicate vasospasm. Hypertension and hypervolemia were induced in all patients with vasospasm, nimodipine was routinely given. The occurrence of fixed delayed ischemic neurological deficits (DIND) with CT-proven hypodensities was monitored.
Results
There were 462 patients younger (group I), and 263 patients of or older than 60 years (group II). Vasospasm occurred in 229 of the 462 group I patients (49.6 %) and in 64 of the 263 group II patients (24.3 %) (p<0.05). Despite antivasospastic therapy, a vasospasm-associated fixed DIND or death could not be prevented in 19 group I patients (4 %), and in 1 group II patient (0.4 %) (p<0.05). The blood flow velocities in patients with vasospasm were significantly higher in group I (171 versus 147 cm/s).
Conclusions
The results clearly indicate, that the incidence of vasospasm post-SAH is significantly lower in older patients. Furthermore, if vasospasm develop in elderly, its effect on morbidity and mortality is minimal. A reduced vessel reagibility to vasoactive substances (as suggested by the lower blood flow velocities in the older patients) is the explanation for the clinical findings.