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The effect of intermittent positive pressure ventilation upon the calibre of cerebral arteries in spasm following subarachnoid haemorrhage – a preliminary communication

Neuroradiology Service and Department of Anaesthesia, St. Bartholomew's Hospital, London, E.C.1

This excerpt was created in the absence of an abstract.

The trial of intermittent positive pressure ventilation (I.P.P.V.) during carotid angiography under general anaesthesia afforded an opportunity to study the effects of alteration of the PaCO₂ on the calibre of cerebral arteries, especially those in spasm following subarachnoid haemorrhage.

As is now well known, in some cases post-haemorrhagic cerebral ischaemia resolves itself over a period of days or weeks as the intense vasoconstriction passes off; in others death or permanent neural damage result (Wilson, Rigg and Rupp, 1954; Tomlinson, 1959; Connolly, 1962). So far as we are aware no useful advance on Echlin's work in 1942 has resulted in any pharmacological method of dilating cerebral arteries which are in a condition of spasm. They are in fact widely believed to be unreactive. du Boulay (1963) measuring the calibre of cerebral arteries shown angiographically, detected no alteration in calibre during the course of single investigations under more or less stable conditions.

The cause of spasm following subarachnoid haemorrhage remains undecided. Florey (1925) and Echlin (1939; 1942) showed in experimental animals that minor traumatic stimuli may result in severe localised constriction of intra-crahial arteries, both over the cerebral cortex and at the base, and Johnson, Potter and Reid (1958) confirmed that this could also happen in the human subject. Echlin reported in 1965 that blood itself when brought into contact with the basilar artery of monkeys caused marked vasoconstriction.