To the Editor.
—In his reminiscence, Treatment of Aneurysmal Subarachnoid Hemorrhage, Aring1 mentions the demonstration of vasospasm in the arteriogram after such hemorrhage.2 Since then it has been suggested that such vasospasm may precede and contribute to the development of cerebral arterial aneurysms.3,4Most neurosurgeons consider that cerebral ischemia from vasospasm is the major cause of morbidity and mortality in patients with subarachnoid hemorrhage following rupture of a cerebral arterial aneurysm.5,6 Yet Aring1 quotes Slosberg6 that vasospasm is not a factor in his extensive experience. Slosberg's6 management includes prolonged lowering of the patient's blood pressure. Could this program not only prevent secondary hemorrhage but also overcome vasospasm?However, with another regimen, Heros and coworkers7 found that hypotension may precipitate clinical symptoms in a patient who otherwise might have had asymptomatic vasospasm.
Ecker A. Does Spasm Precede Development of Cerebroarterial Aneurysms?. Arch Neurol. 1990;47(9):951. doi:10.1001/archneur.1990.00530090019003