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Redefining Secondary Injury After Subarachnoid Hemorrhage in Light of Multimodal Advanced Neuroimaging, Intracranial and Transcranial Neuromonitoring: Beyond Vasospasm

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Neurovascular Events After Subarachnoid Hemorrhage

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 120))

Abstract

The classic idea that arterial narrowing, called vasospasm (VSP), represents the hallmark of secondary injury after subarachnoid hemorrhage, has been challenged. The more complex and pleiotropic pathophysiological repercussions from the irruption of arterial blood into the subarachnoid layers go beyond the ascribed VSP. Putting adjectives in front of this term, such as “symptomatic,” “microdialytic,” or “angiographic” VSP, is misleading. Delayed cerebral ischemia (DCI) is a better term but remains restrictive to severe hypoperfusive injury and neglects oligemia, edema, and metabolic nonischemic injuries. In recognition of these issues, the international conference on VSP integrated “neurovascular events” into its name (www.vasospasm2013.com) and a multidisciplinary research group was formed in 2010 to study subgroups of DCI/VSP and their respective significance.

In three parts, this tiered article provides a broader definitional envelope for DCI and secondary neurovascular insults after SAH, with a rubric for each subtype of delayed neuronal dysfunction. First, it pinpoints the need for nosologic precision and covers current terminological inconsistency. Then, it highlights the input of neuroimaging and neuromonitoring in defining secondary injurious processes. Finally, a new categorization of deteriorating patients is proposed, going beyond a hierarchical or dichotomized definition of VSP/DCI, and common data elements are suggested for future trials.

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Conflict of Interest Statement

Dr. Kapinos declares that he has no conflict of interest. The articulated interpretations in this article represent solely his personal views.

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  1. Department of Neurosurgery, North Shore-LIJ Health System, 300 Community Drive, Tower, 9th floor, Manhasset, NY, 11030, USA

    Gregory Kapinos MD, MS

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  1. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Javier Fandino

  2. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Serge Marbacher

  3. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Ali-Reza Fathi

  4. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Carl Muroi

  5. Department of Neurosurgery Neurointensive Care Unit, University Hospital Zurich, Zurich, Switzerland

    Emanuela Keller

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Kapinos, G. (2015). Redefining Secondary Injury After Subarachnoid Hemorrhage in Light of Multimodal Advanced Neuroimaging, Intracranial and Transcranial Neuromonitoring: Beyond Vasospasm . In: Fandino, J., Marbacher, S., Fathi, AR., Muroi, C., Keller, E. (eds) Neurovascular Events After Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 120. Springer, Cham. https://doi.org/10.1007/978-3-319-04981-6_44

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