Evaluation and Management of Cerebral Vasospasm after Subarachnoid Hemorrhage

Reema Abdullah H Albalawi,Moudhi Mohammed Alajmi,Danah Kamal Kabrah,Hani Mohammed Alabdaly,Fahad Azib Alghamdi,Rakan M Alotaibi,Khaled Bassam Almadi,Laila Hamad Hakami,Renda Ali Alhabib,Othman Mohammad Alassaf,Abdullah Salem Almalki

doi:10.9734/jpri/2021/v33i60b34645

Abstract

Constriction of the large and medium-sized cerebral arteries following an aneurysmal subarachnoid haemorrhage (aSAH) is a well-known condition that primarily affects the anterior circulation supplied by the internal carotid arteries. SAH is a rare but potentially fatal type of stroke. Across the literature, authors have defined vasospasm using terms such as "symptomatic vasospasm," "delayed cerebral ischemia" (DCI), "transcranial Doppler vasospasm," and "angiographic vasospasm." Because posthemorrhagic vasospasm causes significant neurologic morbidity and death, there has been a great deal of interest and research into its physiologic basis and developing effective preventative and treatment strategies. The triple-H therapy hemodynamic augmentation technique, which includes hypertension, hemodilution, and hypervolemia, has been an important part of the treatment. In this article, we'll look at cerebral vasospasm following subarachnoid haemorrhage, including its causes, epidemiology, evaluation, and, most importantly, management.

Highlights

The constriction of the big and medium-sized cerebral arteries following an aneurysmal subarachnoid haemorrhage is a welldescribed condition that most commonly affects the anterior circulation supplied by the internal carotid arteries
In instances of aneurysmal subarachnoid haemorrhage (aSAH), cerebral vasospasm leading to delayed cerebral ischemia (DCI) remains a prominent consequence and cause of morbidity [1,2,3]
Initial global ischemia induced by aneurysm rupture, increased intracranial pressure (ICP), and reduced perfusion pressure are all factors in immediate brain damage after SAH

Summary

INTRODUCTION

The constriction of the big and medium-sized cerebral arteries following an aneurysmal subarachnoid haemorrhage (aSAH) is a welldescribed condition that most commonly affects the anterior circulation supplied by the internal carotid arteries. Symptomatic vasospasm affects 20% to 40% of SAH patients, and it usually refers to clinical worsening after other plausible reasons for deterioration have been ruled out. This is a subjective diagnosis that might be limited to lowgrade instances with small or unnoticeable differences in the examination. A variety of treatment techniques have been proven to have variable degrees of value in avoiding vasospasm and its subsequent neurologic sequelae, no one therapy approach has been proven to be universally helpful in preventing vasospasm and its subsequent neurologic sequelae [1]. These techniques have been approved as appropriate for the treatment of symptomatic individuals who are not responding to hypertensive medication [1]

ETIOLOGY AND EPIDEMIOLOGY

EVALUATION

MANAGEMENT

CONCLUSION