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Cerebral vasospasm following subarachnoid hemorrhage

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Opinion statement

Cerebral vasospasm and related ischemic stroke continue to be significant complicating factors in the course of many patients with subarachnoid hemorrhage from berry aneurysm rupture. The risk of this well-recognized but poorly understood complication can be estimated on the basis of patient medical history, neurologic examination, and head CT findings. Every patient with possible risk needs specialized neurologic intensive care unit care after aneurysm obliteration. Surgical and pharmacologic wash-out of subarachnoid blood around the basal arteries, proper management of intracranial pressure and fluid status, hyponatremia, hypomagnesemia, and fever, as well as use of calcium channel blockers, have been considered helpful in patient management prior to and with the symptomatic vasospasm development. Transcranial Doppler (TCD) ultrasound is important in detecting vasospasm before the patient suffers ischemic neurologic deficit or infarct. Elevated TCD velocities often initiate the use of triple-H (HHH: hypertension, hemodilution, and hypervolemia) therapy and subsequently guide it. Up to the end of the first 3 weeks after subarachnoid hemorrhage and aneurysm obliteration, development of any focal neurologic deficit or mental deterioration, unless convincingly proven otherwise, is assumed to be from cerebral vasospasm. When a hemodynamically significant vasospasm in the arterial segments of clinical concern is suggested, emergency cerebral angiography with balloon dilatation angioplasty or intra-arterial infusion of vasodilating agents may be helpful in relieving ischemic symptoms.

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References and Recommended Reading

  1. Treggiari-Venzi MM, Suter PM, Romand JA: Review of medical prevention of vasospasm after aneurysmal subarachnoid hemorrhage: a problem of neurointensive care. Neurosurgery 2001, 48:259–262.

    Article  Google Scholar 

  2. Dietrich HH, Dacey RG: Molecular keys to the problems of cerebral vasospasm. Neurosurgery 2000, 46:517–530.

    Article  PubMed  CAS  Google Scholar 

  3. Fisher CM, Kistler JP, Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computed tomographic scanning. Neurosurgery 1980, 6:1–9.

    Article  PubMed  CAS  Google Scholar 

  4. Kistler JP, Crowell RM, Davis KR, et al.: The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology 1983, 33:424–436.

    PubMed  CAS  Google Scholar 

  5. Yundt KD, Grubb Rl, Diringer MN, et al.: Autoregulatory vasodilatation of parenchymal vessels is impaired during cerebral vasospasm. J Cereb Blood Flow Metab 1998, 18:419–424. Demonstrated that parenchymal vessels distal to arteries with angiographic spasm after SAH do not show normal autoregulatory vasodilatation unlike the similar conditions of tissue hypoxia, eg, patients with carotid occlusion, that produce cerebral blood volume increase.

    Article  PubMed  CAS  Google Scholar 

  6. Biller J, Godersky JC, Adams HPJr: Management of aneurysmal subarachnoid hemorrhage. Stroke 1988, 19:1300–1305.

    PubMed  CAS  Google Scholar 

  7. Fisher CM, Roberson GH, Ojemann RG: Cerebral vasospasm with ruptured saccular aneurysm: the clinical manifestations. Neurosurgery 1977, 3:245–248.

    Article  Google Scholar 

  8. MacDonald RL, Weir B: Medical aspects of vasospasm. In Cerebral Vasospasm. Edited MacDonald RL, Weir B. San Diego, CA: Academic Press; 2001:353–428. This very important and peerless work, the first VSP textbook, covers all details one needs to know about VSP.

    Google Scholar 

  9. Corsten L, Raja A, Guppy K, et al.: Contemporary management of subarachnoid hemorrhage and vasospasm: the UIC experience. Surg Neurol 2001, 56:140–150.

    Article  PubMed  CAS  Google Scholar 

  10. Lennihan L, Mayer SA, Fink ME, et al.: Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial. Stroke 2000, 31:383–391.

    PubMed  CAS  Google Scholar 

  11. Egge A, Waterloo K, Sjoholm H, et al.: Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study. Neurosurgery 2001, 49:593–606.

    Article  PubMed  CAS  Google Scholar 

  12. Feigin VL, Rinkel GJE, Algra A, et al.: Calcium antagonist for aneurysmal subarachnoid hemorrhage. Cochrane Database Syst Rev 2002, 2:CD000277.

    Google Scholar 

  13. Boet R, Mee E: Magnesium sulfate in the management of patients with Fisher grade 3 subarachnoid hemorrhage: a pilot study. Neurosurgery 2000, 47:602–607.

    Article  PubMed  CAS  Google Scholar 

  14. Harrigan MR: Cerebral salt wasting syndrome: a review. Neurosurgery 1996, 38:152–160.

    Article  PubMed  CAS  Google Scholar 

  15. Kasuya H, Shimizu T, Kagawa M: The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage: a retrospective analysis of 108 patients. Neurosurgery 1991, 28:56–59.

    Article  PubMed  CAS  Google Scholar 

  16. Ross YB, Rinkel GJ, Vermeulen M, et al.: Antifibrinolytic therapy for aneurysmal subarachnoid hemorrhage. Cochrane Database Syst Rev 2002, 2:CD001245.

    Google Scholar 

  17. Feigin VL, Rinkel GJE, Algra A, et al.: Circulatory volume expansion for aneurysmal subarachnoid hemorrhage. Cochrane Database Syst Rev 2002, 2:CD000483.

    Google Scholar 

  18. Trumble ER, Muizelaar JP, Myseros JS, et al.: Coagulopathy with the use of hetastarch in the treatment of vasospasm. J Neurosurg 1995, 82:44–47.

    PubMed  CAS  Google Scholar 

  19. Soni N: Wonderful albumin. BMJ 1995, 310:887–888.

    PubMed  CAS  Google Scholar 

  20. Mayer SA, Solomon RA, Fink ME, et al.: Effect of 5% albumin solution on sodium balance and blood volume after subarachnoid hemorrhage. Neurosurgery 1998, 42:759–768.

    Article  PubMed  CAS  Google Scholar 

  21. Alderson P, Bunn F, Lebepvre C, et al.: Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2002, 1:CD001208.

    PubMed  Google Scholar 

  22. McDonald CT, Carter BS, Putman C, et al.: Subarachnoid hemorrhage. Curr Treatment Options Cardiovasc Med 2001, 3:429–439.

    Article  Google Scholar 

  23. Smith TP, Enterline D: Endovascular treatment of cerebral vasospasm. State of the art. J Vasc Interv Radiol 2000, 11:547–559. A very well written detailed description of the contemporary interventional VSP treatment.

    Article  PubMed  CAS  Google Scholar 

  24. Megyesi JF, Vollrath B, Cook DA, et al.: Long-term effects of in vivo angioplasty in normal and vasospastic canine carotid arteries. Pharmacological and morphological analyses. J Neurosurg 1999, 91:100–108.

    Article  PubMed  CAS  Google Scholar 

  25. Polin RS, Coenen VA, Hansen CA, et al.: Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 2000, 92:284–290.

    PubMed  CAS  Google Scholar 

  26. Muizelaar JP, Zwienenberg M, Rudisill NA, et al.: The prophylactic use of transluminal balloon angioplasty in patients with Fisher grade 3 subarachnoid hemorrhage: a pilot study. J Neurosurg 1999, 91:51–58.

    PubMed  CAS  Google Scholar 

  27. Rosenwasser RH, Armonda RA, Thomas JE, et al.: Therapeutic modalities for the management of cerebral vasospasm: Timing of endovascular options. Neurosurgery 1999, 44:975–980.

    Article  PubMed  CAS  Google Scholar 

  28. Vajkoczy P, Horn P, Bauhuf C, et al.: Effect of intraarterial papaverine on regional cerebral blood flow in hemodynamically relevant cerebral vasospasm. Stroke 2001, 32:498–505. Study using thermal diffusion probes in humans, which elegantly demonstrates that the beneficial effect of IAP on cerebral hypoperfusion vanishes within 3 hours after treatment.

    PubMed  CAS  Google Scholar 

  29. Firlik KS, Kaufmann Am, Firlik AD, et al.: Intra-arterial papaverine for the treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Surg Neurol 1999, 51:66–74.

    Article  PubMed  CAS  Google Scholar 

  30. Elliot JP, Newell DW, Derek JL, et al.: Comparison of balloon angioplasty and papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 1998, 88:277–284.

    Article  Google Scholar 

  31. Mathis JM, Jensen ME, Dion JE: Technical considerations on intra-arterial papaverine hydrochloride for cerebral vasospasm. Neuroradiology 1997, 39:90–98.

    Article  PubMed  CAS  Google Scholar 

  32. Giardano MJ, Pryor JC, Moran CJ, et al.: Intra-arterial papaverine may significantly increase intracranial pressure [meeting abstract]. Presented at the Congress of Neurological Surgeons. Chicago, IL: 1994.

  33. Thomas JE, Rosenwasser RH: Reversal of severe vasoconstriction in three patients after aneurysmal subarachnoid hemorrhage: initial observations regarding the use of intraventricular sodium nitroprusside in humans. Neurosurgery 1999, 44:48–58.

    Article  PubMed  CAS  Google Scholar 

  34. Thomas JE, Rosenwasser RH, Armonda AR, et al.: Safety of intrathecal sodium prusside for the treatment and prevention of refractory cerebral vasospasm and ischemia in humans. Stroke 1999, 30:1409–1416.

    PubMed  CAS  Google Scholar 

  35. Kwan AL, Lin CL, Yanamoto H, et al.: Systemic administration of the potassium channel activator cromakalim attenuates cerebral vasospasm after experimental subarachnoid hemorrhage. Neurosurgery 1998, 42:347–351.

    Article  PubMed  CAS  Google Scholar 

  36. Kasuya H, Onda H, Takeshita M, et al.: Efficacy and safety of nicardipin prolonged-release implants for preventing vasospasm in humans. Stroke 2002, 33:1011–1015.

    Article  PubMed  CAS  Google Scholar 

  37. Effect of calcitonin-gene-related peptide with delayed postoperative cerebral ischemia after aneurysmal subarachnoid hemorrhage [no authors listed]. Lancet 1992, 339:831–834.

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Authors and Affiliations

  1. Stroke Service, Massachusetts General Hospital, 55 Fruit Street, VBK 802, 02114, Boston, MA, USA

    M. Akif Topcuoglu MD, Johnny C. Pryor MD, Christopher S. Ogilvy MD & J. Philip Kistler MD

  2. Department of Neurology and Interventional Neuroradiology and Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, VBK 802, 02114, Boston, MA, USA

    Johnny C. Pryor MD

  3. Department of Neurovascular Surgery, Massachusetts General Hospital, 55 Fruit Street, VBK 802, 02114, Boston, MA, USA

    Christopher S. Ogilvy MD

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  1. M. Akif Topcuoglu MD
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  3. Christopher S. Ogilvy MD
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  4. J. Philip Kistler MD
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Topcuoglu, M.A., Pryor, J.C., Ogilvy, C.S. et al. Cerebral vasospasm following subarachnoid hemorrhage. Curr Treat Options Cardio Med 4, 373–384 (2002). https://doi.org/10.1007/s11936-002-0017-1

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