Treatment of Intracranial Vasospasm Following Subarachnoid Hemorrhage

Overview

Journal Front Neurol

Specialty Neurology

Date 2014 Jun 7

PMID 24904517

Citations 25

Authors

Andrew M Bauer

Peter A Rasmussen

Affiliations

Soon will be listed here.

Abstract

Vasospasm has been a long known source of delayed morbidity and mortality in aneurysmal subarachnoid hemorrhage patients. Delayed ischemic neurologic deficits associated with vasospasm may account for as high as 50% of the deaths in patients who survive the initial period after aneurysm rupture and its treatment. The diagnosis and treatment of vasospasm has still been met with some controversy. It is clear that subarachnoid hemorrhage is best cared for in tertiary care centers with modern resources and access to cerebral angiography. Ultimately, a high degree of suspicion for vasospasm must be kept during ICU care, and any signs or symptoms must be investigated and treated immediately to avoid permanent stroke and neurologic deficit. Treatment for vasospasm can occur through both ICU intervention and endovascular administration of intra-arterial vasodilators and balloon angioplasty. The best outcomes are often attained when these methods are used in conjunction. The following article reviews the literature on cerebral vasospasm and its treatment and provides the authors' approach to treatment of these patients.

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References

Thome C, Seiz M, Schubert G, Barth M, Vajkoczy P, Kasuya H . Nicardipine pellets for the prevention of cerebral vasospasm. Acta Neurochir Suppl. 2010; 110(Pt 2):209-11. DOI: 10.1007/978-3-7091-0356-2_38. View

Otawara Y, Ogasawara K, Ogawa A, Sasaki M, Takahashi K . Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiography. Neurosurgery. 2002; 51(4):939-42; discussion 942-3. DOI: 10.1097/00006123-200210000-00015. View

Zabramski J, Spetzler R, Lee K, Papadopoulos S, Bovill E, Zimmerman R . Phase I trial of tissue plasminogen activator for the prevention of vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 1991; 75(2):189-96. DOI: 10.3171/jns.1991.75.2.0189. View

Pickard J, Murray G, Illingworth R, Shaw M, Teasdale G, Foy P . Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ. 1989; 298(6674):636-42. PMC: 1835889. DOI: 10.1136/bmj.298.6674.636. View

Bejjani G, Bank W, Olan W, Sekhar L . The efficacy and safety of angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery. 1998; 42(5):979-86; discussion 986-7. DOI: 10.1097/00006123-199805000-00013. View

Sloan M, Alexandrov A, Tegeler C, Spencer M, Caplan L, Feldmann E . Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2004; 62(9):1468-81. DOI: 10.1212/wnl.62.9.1468. View

Zubkov Y, NIKIFOROV B, Shustin V . Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir (Wien). 1984; 70(1-2):65-79. DOI: 10.1007/BF01406044. View

Al-Tamimi Y, Orsi N, Quinn A, Homer-Vanniasinkam S, Ross S . A review of delayed ischemic neurologic deficit following aneurysmal subarachnoid hemorrhage: historical overview, current treatment, and pathophysiology. World Neurosurg. 2010; 73(6):654-67. DOI: 10.1016/j.wneu.2010.02.005. View

Darby J, Yonas H, Marks E, Durham S, Snyder R, Nemoto E . Acute cerebral blood flow response to dopamine-induced hypertension after subarachnoid hemorrhage. J Neurosurg. 1994; 80(5):857-64. DOI: 10.3171/jns.1994.80.5.0857. View

10.

Weir B, Grace M, Hansen J, Rothberg C . Time course of vasospasm in man. J Neurosurg. 1978; 48(2):173-8. DOI: 10.3171/jns.1978.48.2.0173. View

11.

Aburto-Murrieta Y, Marquez-Romero J, Bonifacio-Delgadillo D, Lopez I, Hernandez-Curiel B . Endovascular treatment: balloon angioplasty versus nimodipine intra-arterial for medically refractory cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Vasc Endovascular Surg. 2012; 46(6):460-5. DOI: 10.1177/1538574412454585. View

12.

Ecker A, RIEMENSCHNEIDER P . Arteriographic demonstration of spasm of the intracranial arteries, with special reference to saccular arterial aneurysms. J Neurosurg. 1951; 8(6):660-7. DOI: 10.3171/jns.1951.8.6.0660. View

13.

Siironen J, Juvela S, Varis J, Porras M, Poussa K, Ilveskero S . No effect of enoxaparin on outcome of aneurysmal subarachnoid hemorrhage: a randomized, double-blind, placebo-controlled clinical trial. J Neurosurg. 2004; 99(6):953-9. DOI: 10.3171/jns.2003.99.6.0953. View

14.

Velat G, Kimball M, Mocco J, Hoh B . Vasospasm after aneurysmal subarachnoid hemorrhage: review of randomized controlled trials and meta-analyses in the literature. World Neurosurg. 2011; 76(5):446-54. DOI: 10.1016/j.wneu.2011.02.030. View

15.

Linn F, Rinkel G, Algra A, van Gijn J . Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke. 1996; 27(4):625-9. DOI: 10.1161/01.str.27.4.625. View

16.

Allen G, Ahn H, Preziosi T, Battye R, Boone S, CHOU S . Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med. 1983; 308(11):619-24. DOI: 10.1056/NEJM198303173081103. View

17.

Mayberg M, Batjer H, Dacey R, Diringer M, HALEY E, Heros R . Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Circulation. 1994; 90(5):2592-605. DOI: 10.1161/01.cir.90.5.2592. View

18.

Webb A, Kolenda J, Martin K, Wright W, Samuels O . The effect of intraventricular administration of nicardipine on mean cerebral blood flow velocity measured by transcranial Doppler in the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2009; 12(2):159-64. DOI: 10.1007/s12028-009-9307-8. View

19.

Yoon D, Choi C, Kim K, Cho B . Multidetector-row CT angiography of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: comparison of volume-rendered images and digital subtraction angiography. AJNR Am J Neuroradiol. 2006; 27(2):370-7. PMC: 8148759. View

20.

Solomon R, Fink M, Lennihan L . Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid hemorrhage. Neurosurgery. 1988; 23(6):699-704. DOI: 10.1227/00006123-198812000-00002. View