Disturbance of autoregulation in patients with ruptured intracranial aneurysms: mechanism of cortical and motor dysfunction.

Serial measurements of local cerebral blood flow were obtained with inhalation of stable xenon and computed tomography prior to and during induced hypertension with continuous infusion of dopamine (7-15 micrograms/kg/min) in 34 patients who underwent surgery for treatment of subarachnoid hemorrhage due to ruptured intracranial aneurysm. Cerebral vasospasm was detected angiographically in all but one of the patients studied. Vasospasm was not symptomatic in 19 patients, but was in the other 15 patients. Disturbance of autoregulation was observed just after surgical operation. In the latter group, local cerebral blood flow in the territory of the middle cerebral artery and the corona radiata on the craniotomy side reached their lowest values, 25.1 +/- 6.8 mL/100 g/min and 15.7 +/- 1.8 mL/100 g/min, respectively, on days 10-14, and each subsequently increased significantly, to 34.3 +/- 7.3 mL/100 g/min and 19.9 +/- 2.0 mL/100 g/min, respectively, during induced hypertension. In conclusion, cortical dysfunction and motor palsy in the patients studied here were thought to be due to significant reduction in local cerebral blood flow in the cortical territories of the middle cerebral artery and corona radiata, respectively.