Clinical and biochemical disorders in patients with ruptured cerebral aneurysms in the pre- and postoperative periods

Vascular spasm and delayed cerebral ischemia are the most common complications of aneurysmal subarachnoid hemorrhage (ASAH), which lead to clinical deterioration and increased mortality. mechanisms leading to the development of complications after rupture of cerebral aneurysms and ASAH, as well as their surgical treatment, have been studied actively recently.

PURPOSE OF THE STUDY: to assess the severity of clinical manifestations of ASAH and the quality of clipping of cerebral aneurysms, to study the indicators of the pro-antioxidant system, vasoregulatory metabolites, platelet aggregation in the patients’ blood in the pre- and postoperative periods.

MATERIALS AND METHODS: we examined 31 patients operated on the 8th (5; 10) day after cerebral aneurysm rupture and development of ASAH. The studies were performed at the time of admission of patients to the hospital, on the 2^nd and 10^th days after microsurgical clipping of the cerebral aneurysms. The severity of the condition was assessed using the Hunt-Hess, WFNS, NIHSS and Glasgow coma scales. An MRI study was performed to diagnose cerebral ischemia. We studied the indicators of the pro-, antioxidant system of the blood, the concentration of nitrates/ nitrites, angiotensin-converting enzyme, and platelet aggregation. The indicators of 26 healthy individuals were used for comparison.

RESULTS. There was no statistically significant difference in the severity of the condition according to the hunthess, WFNS, NIHSS, and GCS scales in patients, operated on the 8^th (5; 10) day after cerebral aneurysm rupture and the development of ASAH before and after microsurgical clipping of the aneurysm neck. An increase in the concentration of secondary products of lipid peroxidation (p=0.002), a decrease in the activity of superoxide dismutase (p=0.003), an increase in the rate of platelet aggregation (p=0.004), a decrease in the concentrations of nitrates/nitrites (p˂0.001) and angiotensinconverting enzyme (p =0.037) relative to the norm were established before treatment. A decrease in the imbalance of the pro-, antioxidant system and vasoregulatory metabolites in the blood with an increase in the hyperaggregation ability of platelets (p=0.006) were revealed in patients on the 10^th day after clipping.

CONCLUSION. The disorders of various severity in the pro-antioxidant state, concentrations of vasoregulatory metabolites, primary hemostasis in patients with cerebral aneurysm rupture were established before and after surgical treatment. This disorders can lead to increased thrombus formation in the cerebral vasculature, impaired microcirculation and development of the delayed cerebral ischemia.

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