May 21, 2015: Cerebral vasospasm in subarachnoid hemorrhage
May 21, 2015
Cerebral vasospasm in subarachnoid hemorrhage
Cerebral vasospasm following a subarachnoid hemorrhage carries a high mortality. Prevention and early recognition are key to minimizing the morbidity and mortality associated with this condition. The highest risk for cerebral vasospasm occurs between days 3-14 following subarachnoid hemorrhage, with a peak around days 6-8. It is clinically significant in upwards of 30% of patients. It is one cause of delayed cerebral ischemia (DCI), which also carries a high mortality and morbidity. Patients frequently present with headache, neck stiffness and focal neurological deficits. Conventional angiography remains the gold standard for diagnosis, although less invasive tests such as Transcranial Doppler, which show increased velocities, and cerebral perfusion studies are also being utilized. Modalities such as near-infrared spectroscopy are able to provide continuous and non-invasive monitoring for regional changes in metabolic and oxygen parameters, with a limitation of only covering a regional area. The mainstay of treatment remains close neurological exams and the use of calcium-channel blockers such as Nimodipine 60 mg every 4 hours.
- Bacigaluppi S, Zona G, Secci F, et al. Diagnosis of cerebral vasospasm and risk of delayed cerebral ischemia related to aneurysmal subarachnoid hemorrhage: an overview of available tools. Neurosurgery 2015. [Epub ahead of print].
Submitted by James Addington, M.D. Resident Physician, Department of Neurology University of Virginia
Disclosures: Dr. Addington is a member of the Residents & Fellows Section of Neurology.