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Management of cerebral vasospasm

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Abstract

Cerebral vasospasm is delayed narrowing of the large arteries of the circle of Willis occurring 4 to 14 days after aneurysmal subarachnoid hemorrhage (SAH). It is but one cause of delayed deterioration after SAH but, in general, is the most important potentially treatable cause of morbidity and mortality after SAH. Development of vasospasm is best predicted by the volume, location, persistence and density of subarachnoid clot early after SAH. Diagnosis is made by catheter angiography or, with less accuracy, by computed tomographic angiography, transcranial Doppler ultrasound or other methods. Treatment remains problematic because it is expensive, time-consuming, associated with substantial risk and largely ineffective. Treatment includes optimization of factors that affect cerebral blood flow and metabolism, systemic administration of nimodipine, hemodynamic therapy and pharmacologic and mechanical angioplasty.

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  1. Section of Neurosurgery, MC3026, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, Illinois, 60637, USA

    R. Loch Macdonald

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P. Vajkoczy, Mannheim, Germany

Cerebral vasospasm is one of the most serious complications of aneurysmal SAH. Angiographic vasospasm is detected in 50% to 70% of patients with SAH, but symptomatic vasospasm leading to a DIND occurs in 19% to 46% of SAH patients, and 64% of the DIND patients will develop infarction. The hemodynamically relevant or symptomatic vasospasm remains a leading cause of morbidity and mortality after SAH.

In the present manuscript, Dr. Macdonald reviews the current knowledge and literature on the epidemiology, pathophysiology, diagnosis, investigations, treatment, and prognosis of cerebral vasospasm. This manuscript provides an excellent expert and in depth review of the contemporary management of cerebral vasospasm. The timing of this review is certainly perfect since several novel aspects in the diagnosis and treatment of this disease have recently occurred. Based on these recent developments it is fair enough to speculate that the future in treating cerebral vasospasm is bright and that our patients will soon profit from the past investments in a better understanding of the pathophysiological and molecular mechanisms underlying the disease. This review will certainly serve as a key reference in the future.

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Loch Macdonald, R. Management of cerebral vasospasm. Neurosurg Rev 29, 179–193 (2006). https://doi.org/10.1007/s10143-005-0013-5

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  • DOI: https://doi.org/10.1007/s10143-005-0013-5

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