A study on changes of plasma catecholamines concentrations and clinical prognosis in patients with ruptured intracranial aneurysms
Ikeda, Y.; Nakazawa, S.
No Shinkei Geka. Neurological Surgery 12(5): 571-578
1984
ISSN/ISBN: 0301-2603 PMID: 6462355 Document Number: 232721
Plasma catecholamine [CA] concentrations are generally accepted as an index of sympathetic nervous activity in cardiovascular and neurologic disorders. Intracranial vessels are innervated by sympathetic nerve fibers. The plasma norepinephrine (NE) levels is related to the sympathetic activity. Consequently, changes in sympathetic nervous function are accompanied by the release of NE at the sympathetic nerve terminals. There are many reports on the correlation between autonomic nervous system dysfunction and the presence of cerebral arterial spasm, systemic hypertension and ECG evidence of myocardial necrosis after subarachnoid hemorrhage. Whether the measurement of plasma CA concentrations could assess clinical status and have a prognostic value was studied. The plasma NE, epinephrine (E) and dopamine (DA) concentrations in 30 patients with ruptured intracranial aneurysms was examined. Within 48 h of admission, all patients were evaluated by Hunt and Hess grade depending on the clinical findings. Blood pressure estimations, ECG tracing and a blood sample were obtained. The clinical outcome of the patients was assessed on discharge. The good group consisted of patients who recovered completely or with minimal disabilities, and could lead independent lives. The blood samples were assayed by the high performance liquid chromatography. Plasma NE levels in the patients with ruptured intracranial aneurysms were significantly higher than those in the patients with brain tumors and non-neurological diseases. Plasma E levels in the patients with intracranial aneurysms were also higher than the concentrations in the patients with brain tumors and non-neurological diseases. In the good group, plasma NE levels of the last sample showed a tendency to decrease, while in dead group plasma NE levels showed a significant increase, as compared with those of the 1st samples which were similar to E levels. Plasma DA levels in the good and dead groups showed variable changes according to each case. The dead group showed an early rise in plasma NE and E levels postoperatively. The good group showed a sustained decrease in plasma NE and E levels after end of surgery. The relation between sequential changes of plasma CA in patients with vasospasms and rebleeding, and the outcome was also discussed. The systemic metabolic response to subarachnoid hemorrhage due to the rupture of intracranial aneurysms and its relatinship to outcome was studied. High plasma CA levels, evidence of increased sympathetic nervous system activity, showed a good correlation with subsequent morbidity and mortality. This measurement may prove useful in making prognosis following subarachnoid hemorrhage and be valuable in selecting suitable patients for operations. It is necessary to consider suitable treatment with the function of the autonomic nervous system considered.