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Semin Neurol 2013; 33(05): 488-497
DOI: 10.1055/s-0033-1364216
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Arterial Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Joshua R. Dusick
1   Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California
,
Nestor R. Gonzalez
2   Departments of Neurosurgery and Radiology, UCLA David Geffen School of Medicine, Los Angeles, California
› Author Affiliations
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Publication History

Publication Date:
06 February 2014 (online)

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Abstract

Despite recent advances, cerebral vasospasm and delayed cerebral ischemia (DCI) still represent a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Although a significant portion of the morbidity and mortality associated with aSAH is related to the initial hemorrhagic ictus, cerebral vasospasm and DCI are still the leading cause of poor outcomes and death in the acute posthemorrhage period, causing long-term disability or death in more than one in five of all patients who have suffered aSAH and initially survived.

Management of patients following aSAH includes four major considerations: (1) prediction of patients at highest risk for development of DCI, (2) prophylactic measures to reduce its occurrence, (3) monitoring to detect early signs of cerebral ischemia, and (4) treatments to correct vasospasm and cerebral ischemia once it occurs. The authors review the pertinent literature related to each, including both the current management guidelines supported by the literature as well as novel management strategies that are currently being investigated.

Keywords

vasospasm - subarachnoid hemorrhage - stroke - delayed cerebral ischemia
 

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