Origins of the Concept of Vasospasm

Celsus may have described subarachnoid hemorrhage (SAH) when he wrote in A.D. 30, “The characteristic marks… are strong shivering, nervous relaxation, dimness of sight, delirium, vomiting together with a suppression of voice, besides these symptoms there is a violent pain chiefly about the temples or occiput”.1 Hippocrates in Aphorisms on Apoplexy probably described a case: “When persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor, they die in seven days.” Neglecting the patient who would in those days die rapidly without articulating their history, could this be a description of “vasospasm,” or in current terminology, delayed cerebral ischemia (DCI)?Aneurysms were well known to the ancients, but those located intracranially eluded detection by virtue of being encased in the cranium and not palpable or large and easily accessible to clinical or postmortem assessment. McDonald and Korb2 credited Biumi with describing in 1778 the first pathologically verified case of ruptured intracranial aneurysm. Weir wrote that Gull may have been the first to describe DCI in a 30-year-old female in 1859: “while walking, she suddenly called out, ‘Oh, my head’ and put up her left hand. She vomited, and her friend thought, fainted. After a brief interval she partially recovered, and was able to walk back to her residence with the support of two men. When admitted to the hospital at noon the following day, only a slight impression could be made by any attempt to rouse her. The right arm was quite paralysed, the muscles flaccid; the right leg in the same condition….”3The text goes on to describe improvement in her condition such that on day 4 she could talk and eat. However, on the fifth day she deteriorated and died and was found …