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Detection and Monitoring of Vasospasm and Delayed Cerebral Ischemia: A Review and Assessment of the Literature

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Abstract

Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage can be evaluated using clinical assessment, non-invasive and invasive techniques. An electronic literature search was conducted on English-language articles investigating DCI in human subjects with subarachnoid hemorrhage. A total of 31 relevant papers were identified evaluating the role of clinical assessment, transcranial Doppler, computed tomographic angiography, and computed tomographic perfusion. Clinical assessment by bedside evaluations is limited, especially in patients initially in poorer clinical condition or who are receiving sedative medication for whom deterioration may be more difficult to identify. Transcranial Doppler is a useful screening tool for middle cerebral artery vasospasm, with less utility in evaluating other intracranial vessels. Computed tomographic angiography correlates well with digital subtraction angiography. Computed tomographic perfusion may help predict DCI when used early or identify DCI when used later.

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Authors and Affiliations

  1. Department of Neurological Surgery and Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8057, St. Louis, MO, 63110, USA

    Chad W. Washington & Gregory J. Zipfel

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  1. Chad W. Washington
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The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage

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Correspondence to Gregory J. Zipfel.

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The Participants in the International Multi-disciplinary Consensus Conference: Michael N. Diringer, Thomas P. Bleck, Nicolas Bruder, E. Sander Connolly, Jr., Giuseppe Citerio, Daryl Gress, Daniel Hanggi, J. Claude Hemphill, III, MAS, Brian Hoh, Giuseppe Lanzino, Peter Le Roux, David Menon, Alejandro Rabinstein, Erich Schmutzhard, Lori Shutter, Nino Stocchetti, Jose Suarez, Miriam Treggiari, MY Tseng, Mervyn Vergouwen, Paul Vespa, Stephan Wolf, Gregory J. Zipfel.

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Washington, C.W., Zipfel, G.J. & The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage. Detection and Monitoring of Vasospasm and Delayed Cerebral Ischemia: A Review and Assessment of the Literature. Neurocrit Care 15, 312–317 (2011). https://doi.org/10.1007/s12028-011-9594-8

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  • DOI: https://doi.org/10.1007/s12028-011-9594-8

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