Vasospasm In Aneurysmal Subarachnoid Hemorrhage Research Articles

The Predictive Value of PKC and ET-1 Levels in Cerebrospinal Fluid for Vasospasm and Prognosis in Patients with Aneurysmal Subarachnoid Hemorrhage.

To analyze the predictive value of protein kinase C (PKC) and endothelin-1 (ET-1) in cerebrospinal fluid for vasospasm and prognosis in patients with aneurysmal subarachnoid hemorrhage (ASH). One hundred and forty-eight ASH patients hospitalized in our hospital during February 2019 to February 2022 were optioned as observation subjects. These subjects were graded into good prognosis group (mRS score 0-2, n = 102) and poor prognosis group (mRS score 3-6, n = 46) according to the Rankin Revised Scale Score (mRS) after 6 months of follow-up. Cerebrospinal fluid was collected from patients to detect the content of ET-1 and PKC. The prognostic factors were analyzed using multifactorial logistic regression. The predictive value was assessed using receiver operating characteristic (ROC) curve. The patients with poor prognosis had a higher age level and a higher proportion of ≥2 aneurysms, aneurysm diameter ≥6 mm, cerebral vasospasm, and Hunt-Hess grade ≥III than those with good prognosis (P < 0.05). The patients with poor prognosis had higher content of PKC and ET-1 than those with good prognosis (P < 0.05). Age, aneurysm diameter ≥6 mm, cerebral vasospasm, Hunt-Hess classification ≥grade III, PKC and ET-1 were all risk factors related to the prognosis of ASH (P < 0.05). The area under the curve (AUC) of PKC and ET-1 for diagnosing poor prognosis of ASH was 0.803 and 0.720, respectively. The AUC of the combined detection was 0.873 (P < 0.05). Patients with cerebrovascular spasm had higher content of PKC and ET-1 than those without (P < 0.05). The AUC of PKC and ET-1 for diagnosing cerebral vasospasm in ASH was 0.891 and 0.816, respectively, which was 0.932 for combined detection (P < 0.05). The combination of PKC and ET-1 in cerebrospinal fluid had certain value in predicting the poor prognosis of patients with ASH.

CLR (C-Reactive Protein to Lymphocyte Ratio) Served as a Promising Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage (aSAH): A Retrospective Cohort Study.

Background: Subarachnoid hemorrhage is a devastating disease. Even after state-of-the-art treatment patients suffer from complications, including cerebral vasospasm (CVS), delayed cerebral ischemia (DCI), and chronic hydrocephalus (CH) following aneurysmal subarachnoid hemorrhage (aSAH). The aim of our study is to identify the predictive value of the C-reactive protein to lymphocyte ratio (CLR) for neurological functional outcome and complications after aSAH. Methods: We retrospectively analyzed a total of 166 aSAH patients who met the inclusion criteria enrolled in our study. Multivariate logistic regression analyses were performed to evaluate the independent risk factors. The predictive value of different models was compared by calculating the areas under the receiver operating characteristic (ROC) curve. Results: On-admission levels of CLR in patients with poor outcomes (6 months mRS 3-6), CVS, DCI, and CH were significantly higher than those in patients with good outcomes (6 months mRS 0-2), non-CVS, non-DCI, and non-CH. Multivariate logistic regression analysis revealed that admission CLR was independently associated with CVS (OR [95% CI] 2.116 [1.507-2.971]; p < 0.001), and DCI (OR [95% CI] 1.594 [1.220-2.084]; p = 0.001). In ROC analysis, the area under the curve (AUC) of CLR for poor outcomes (6 months mRS 3-6), CVS, DCI, and CH prediction were (AUC [95% CI] 0.639 [0.555-0.724]; p = 0.002), (AUC [95% CI] 0.834 [0.767-0.901]; p < 0.001), (AUC [95% CI] 0.679 [0.581-0.777]; p < 0.001), and (AUC [95% CI] 0.628 [0.543-0.713]; p = 0.005) revealing that admission CLR had a favorable predictive value for CVS after aSAH. The sensitivity and specificity of admission CLR for CVS prediction were 77.1% and 75.4%. On-admission CLR of 0.757 mg × 10-6 was identified as the best cutoff threshold to discriminate between CVS and non-CVS (CVS: CLR < 0.757 mg × 10-6 11/100 [11.0%] vs. CLR ≥ 0.757 mg × 10-6 37/66 [56.1%]; p < 0.001). Conclusions: High levels of on-admission CLR serve as an independent risk factor for CVS and DCI after aSAH. Admission CLR is an easy-to-quantify laboratory parameter that efficiently predicts the CVS after aSAH, which can provide some guidance for clinicians to evaluate for possible progression and treatment strategies in patients with aSAH.

Role of albumin-induced volume expansion therapy for cerebral vasospasm in aneurysmal subarachnoid hemorrhage: A systematic review.

This study reviews the effect of albumin-induced volume expansion therapy on symptomatic vasospasm and clinical outcome in aneurysmal subarachnoid hemorrhage (aSAH). Computer searches carried out from the Scopus, Medline, Embase, Web of Science, the Cochrane Library, and Internet documents; hand searching of medical journals; and review of reference lists. Randomized controlled trials (RCT) and observational studies (OSs) comparing albumin therapy in combination or alone with crystalloid therapy for the treatment of cerebral vasospasm in aSAH were included in the study. Risk-of-bias assessment was conducted using ROB2.0 and ROBINS-I tools for RCTs and Oss, respectively. Out of a total of 1078 searches, one RCT (published in two articles) and one observational (retrospective) study were included for final analysis. In RCT, albumin was used for volume expansion therapy with a baseline crystalloid regime and comparison made between hypervolemic and normovolemic groups and it showed no beneficial effects on symptomatic vasospasm and clinical outcomes based on the Glasgow outcome scale. Furthermore, the use of albumin showed a tendency for sodium retention with lowering of glomerular filtration rate, limiting the amount of total fluid required for targeted central venous pressure values, and thereby avoiding fluid overload manifestations. The retrospective study results between albumin versus non-albumin groups (crystalloids only) supported improved outcomes in the former group with lower in-hospital mortality. Cardiorespiratory complications were equivocal in RCT and increased in non-albumin group in the retrospective study. Risk-of-bias assessment analyses revealed "some concerns" in RCT and "serious" limitation in OS due to its retrospective design. Albumin-induced volume expansion therapy for cerebral vasospasm does not have substantiative evidence to improve cerebral vasospasm and clinical outcomes in aSAH. Studies with well-designed RCTs are required to compare the use of albumin for volume expansion therapy versus standard fluid management using crystalloids to mitigate the scarcity of published data.

A Machine Learning Tool to Predict Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage (P13-7.003)

<h3>Objective:</h3> To utilize a machine learning and deep learning approach to derive a clinically applicable tool to predict the development of vasospasm in aneurysmal subarachnoid hemorrhage (aSAH) patients. <h3>Background:</h3> Cerebral vasospasm, is a common undesired and feared consequence of aSAH occurring in up to 70% of patients. Cerebral vasospasm may present anywhere from 24 hours to 7–10 days post SAH and is difficult to predict. Several radiological and clinical features have been proposed as potential predictors of cerebral vasospasm in previous models including, however, these predictors have not successfully been standardized and weighted through an artificial intelligence algorithm. While risk factors for vasospasm is known, there is also no validated single tool in practice that accounts for the broad diversity in indicators that may be predictive of cerebral vasospasm. <h3>Design/Methods:</h3> We retrospectively analyzed aneurysmal SAH patients who were admitted to the Carle Foundation Hospital in the Critical Care Unit from January 2016 to December 2021. Total of 52 patients met study criteria, out of which 23 (44%) patients were identified to have vasospasm through diagnostic imaging modalities. Clinical, radiological, and laboratory data were collected and analyzed through various feature selection and artificial intelligence models. Models were validated using 10-fold Cross-Validation. <h3>Results:</h3> We included Transcranial Doppler data from 14 days post aSAH, as well as Fisher Score, Hunt Hess Score, diameter of aneurysm, lymphocyte/monocyte/WBC counts, motor component from Glasgow Coma Scale, and home medication for anticoagulants in our model. Models including Logistic Model Trees, Logistic Regression, AdaBoost, LogitBoost, Hoeffding Tree, and Multilayer Perceptron (MP) were trained, with MP performing with the highest ROC AUC of 0.829, with a TP Rate of 73%, FP Rate of 28.5%, Precision of 73%, and F-Measure of 73%. <h3>Conclusions:</h3> A framework for predicting cerebral vasospasm after aSAH through deep learning is created with ROC AUC of 0.829. <b>Disclosure:</b> Mr. Patel has nothing to disclose. Mr. Pandya has nothing to disclose. Ms. Mann has nothing to disclose.

Delayed ischemic neurologic deficit with vasospasm in aneurysmal subarachnoid hemorrhage after negative post-bleed day 7 angiography

ObjectiveRoutine post-bleed day 7 (PBD7) angiography has been utilized to evaluate for vasospasm in aneurysmal subarachnoid hemorrhage (SAH). We sought to assess the rate of delayed-cerebral ischemia (DCI) associated with angiographic vasospasm following negative PBD7 angiography. MethodsRetrospective review of 178 aneurysmal SAH patients was performed. Patients underwent routine angiography on or around 7 days after hemorrhage. Primary variables assessed were the rate of vasospasm detection on PBD7 angiograms and rate of subsequent development of delayed-cerebral ischemia (DCI) associated with angiographic vasospasm in patients without spasm on PBD7. Statistical analysis was carried out for contributing factors. ResultsEighty-four of 178 patients (47.2 %) developed angiographically proven vasospasm during their hospital course. Seven patients (3.9 %) were clinically suspected to have vasospasm prior to PBD7 with radiographic confirmation. Sixty-nine patients (38.8%) demonstrated novel spasm on routine PBD7 angiogram, with 56.5 % of these patients showing vasospasm on angiography obtained after PBD7 for DCI. One hundred and two patients (57.3 %) had no vasospasm on routine PBD7 angiography. Eight patients in the PBD7 spasm-free subgroup went on to develop DCI with angiographic spasm. These 8 patients represent 4.5 % (8/178) of all patients, 7.8 % (8/102) of the PBD7 negative subgroup, and 9.5 % (8/84) of patients with angiographic spasm during admission. ConclusionThe majority of patients (90.4 %) with angiographic vasospasm manifested on or before PBD7. DCI with angiographically-proven spasm arouse infrequently (7.8 %) after negative PBD7 angiography. Further study of PBD7 angiography may help determine which SAH patients in whom shortened length-of-stay might safely be pursued.

The Role of Parenteral Dantrolene in the Contemporary Management of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

Cerebral vasospasm remains a significant source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage. Dantrolene has shown promise in several animal studies in the treatment of cerebral vasospasm. The present study seeks to critically review the evidence of its use in human subjects, aiming to 1) describe the forms and dosages used, 2) describe its safety profile, and 3) describe its effectiveness in treating cerebral vasospasm. A systematic review of intra-arterial dantrolene use in cerebral vasospasm was performed. A total of 86 articles were identified across all databases, 6 of which were ultimately included in the present study. Primary outcomes included a description of the form and dosage of dantrolene prescribed, the incidence of adverse effects after dantrolene use, and its efficacy for the treatment of cerebral vasospasm. Study designs included 2 randomized controlled trials (33.3%), 2 case series (33.3%), and 2 case reports (33.3%). Both the intra-arterial and intravenous administration of dantrolene has been performed with varying dose regimens. Although there exists limited clinical information regarding side effects, a case of liver toxicity was reported. All existing studies reported benefit in vasospasm measured either by transcranial Doppler or digital subtraction angiography. The level of evidence was low, consisting largely of retrospective studies that had a high likelihood of bias. Dantrolene is a promising new therapeutic agent in the treatment of cerebral vasospasm. Although existing reports of its use are encouraging, high-quality prospective randomized trials are necessary for recommendations pertaining to dose, route, indications, and efficacy.

Systemic Immune-Inflammation Index Predicts Delayed Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage.

Delayed cerebral vasospasm is a feared complication of aneurysmal subarachnoid hemorrhage (SAH). To investigate the relationship of systemic inflammation, measured using the systemic immune-inflammation (SII) index, with delayed angiographic or sonographic vasospasm. We hypothesize that early elevations in SII index serve as an independent predictor of vasospasm. We retrospectively reviewed the medical records of 289 SAH patients for angiographic or sonographic evidence of delayed cerebral vasospasm. SII index [(neutrophils × platelets/lymphocytes)/1000] was calculated from laboratory data at admission and dichotomized based on whether or not the patient developed vasospasm. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed to determine the ability of SII index to predict the development of vasospasm. A total of 246 patients were included in our study, of which 166 (67.5%) developed angiographic or sonographic evidence of cerebral vasospasm. Admission SII index was elevated for SAH in patients with vasospasm compared to those without (P<.001). In univariate logistic regression, leukocytes, neutrophils, lymphocytes, neutrophil-lymphocyte ratio (NLR), and SII index were associated with vasospasm. After adjustment for age, aneurysm location, diabetes mellitus, hyperlipidemia, and modified Fisher scale, SII index remained an independent predictor of vasospasm (odds ratio 1.386, P=.003). ROC analysis revealed that SII index accurately distinguished between patients who develop vasospasm vs those who do not (area under the curve=0.767, P<.001). Early elevation in SII index can independently predict the development of delayed cerebral vasospasm in aneurysmal SAH.

Abstract P555: Safety and Efficacy of Daily Intra-Arterial Endovascular Therapy for Medically Refractory Cerebral Vasospasm Following Subarachnoid Hemorrhage

Introduction: Delayed cerebral ischemia (DCI) and cerebral infarction due to medically refractory vasospasm in aneurysmal SAH (aSAH) is a major cause of death and disability. The guidelines for endovascular therapy (EVT) for medically refractory vasospasm are not well established, especially regarding duration and frequency of therapy. Methods: Single center retrospective chart review was performed. We included patients with aSAH who had medically refractory vasospasm and underwent EVT. Demographics, clinical characteristics, imaging data, procedural details and outcomes were collected. Results: From 2016 to 2019, 303 subarachnoid hemorrhage (SAH) patients were identified. 133 (43.9%) were aSAH, of which 120 (90.2%) had DCI. Forty-one (34.1%) patients met our inclusion criteria. Median age was 56 years [Interquartile range (IQR) 46, 63] and 33 (80.5%) patients were female. We divided the EVT arm into two groups, group 1 underwent &lt; 3 consecutive days of EVT comprising of 11 patients (26.8%) and group 2 underwent ≥3 consecutive days of EVT comprising of 30 patients (73.2%). Median Hunt and Hess score and Fisher grade were 1.5 (IQR 1,3) and 3.5 (IQR 2,4)in group 1 and 3 (IQR 2,4) and 4 (3,4) in group 2, (p =0.08) and (p =0.5) respectively . Median number of days of EVT was 4(IQR 2,6.5) for the entire cohort. Median days of EVT in group 1 was 2 (IQR 1,2) and for group 2 was 5 (IQR 3,7, p=0.24). Cerebral infarction was seen in 5/11 (45.4%) patients in group 1 and 16/30 (53.3%) patients in group 2 (p = 0.73). Median modified Rankin scale (mRS) at discharge in both groups was 4 (p=0.55, r=0.1). Good clinical outcome at discharge (mRS 0-2) was seen in 4/11 (36.3%) patients in group 1 and 5/30 (16.7%) patients in group 2 (p=0.22). Procedure related complications were seen in 3/11 (27.2%) patients in group 1 and 3/30 (10%) patients in group 2 (p=0.32) whereas mortality rate was 1/11(9.1%) and 8/30 (26.6%) (p=0.4)respectively. No mortality was associated with the procedure. Conclusion: Daily endovascular therapy in medically refractory vasospasm is safe but not efficacious in reducing the rates of cerebral infarctions.

Predictive value of the transcranial Doppler and mean arterial flow velocity for early detection of cerebral vasospasm in aneurysmal subarachnoid hemorrhage

We aimed to predict cerebral vasospasm in acute aneurysmal subarachnoid hemorrhage and to determine the cut-off values of the mean flow velocity by the use of transcranial Doppler. A total of 40 patients with acute aneurysmal subarachnoid hemorrhage were included in this study and classified into two groups. The first group was 26 patients (65%) with cerebral vasospasm and the second group was 14 patients (35%) without vasospasm. Initial evaluation using the Glasgow Coma Scale and the severity of aneurysmal subarachnoid hemorrhage was detected by using both the clinical Hunt and Hess and radiological Fisher grading scales. All patients underwent transcranial Doppler evaluations five times in 10 days measuring the mean flow velocities (MFV) of cerebral arteries. Patients with cerebral vasospasm were associated with significantly higher mean Glasgow Coma Scale score (p = 0.03), significantly higher mean Hunt and Hess scale grades (p = 0.04), with significantly higher mean diabetes mellitus (p = 0.03), significantly higher mean systolic blood pressure and diastolic blood pressure (p = 0.02 and p = 0.005 respectively) and significantly higher MFVs measured within the first 10 days. Logistic regression analysis demonstrated that MFV ≥81 cm/s in the middle cerebral artery is accompanied by an almost five-fold increased risk of vasospasm (OR 4.92, p < 0.01), while MFV ≥63 cm/s in the anterior cerebral artery is accompanied by a three-fold increased risk of vasospasm (OR 3.12, p < 0.01), and MFV ≥42 cm/s in the posterior cerebral artery is accompanied by a two-fold increased risk of vasospasm (OR 2.11, p < 0.05). Transcranial Doppler is a useful tool for early detection, monitoring, and prediction of post subarachnoid vasospasm and valuable for early therapeutic intervention before irreversible ischemic neurological deficits take place.

Risk Factors for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Risk Factors for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Hyperoxia and Delayed Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Hyperoxia and Delayed Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Risk Factors for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Population-Based Study of 8346 Patients

A recent systematic review and meta-analysis found that there was a lack of consensus regarding risk factors for cerebral vasospasm in aneurysmal subarachnoid hemorrhage (aSAH). To identify risk factors associated with increased likelihood of cerebral vasospasm after aSAH using the largest, all-payer, inpatient database in the United States. The Nationwide Readmissions Database (2016) was queried using International Classification of Diseases, Tenth Revision codes to identify patients (age ≥18 years) treated (coiling or clipping) for aSAH. Exposure variables included demographics, comorbidities, location and clinical grade of aSAH, treatment type, and laboratory anomalies. Multivariable analysis was conducted to identify factors independently associated with cerebral vasospasm (ICD-10 code I67.84). The rate of vasospasm was 28.1% in 8346 patients with treated aSAH. In multivariable analysis, vasospasm risk was inversely proportional to age (P<0.001). Substance abuse, particularly tobacco smoking and cocaine, was associated with vasospasm (P < 0.05). Advanced SAH severity (Hunt and Hess grade ≥2) approximately doubled risk of vasospasm (P < 0.001). Poor hemodynamic status, including anemia (odds ratio [OR], 1.8), hypovolemia (OR, 1.6), and hypotension (OR, 1.4), was correlated with vasospasm. Laboratory abnormalities, including leukocytosis (OR, 1.3), hyponatremia (OR, 1.4), and hypokalemia (OR, 1.3), were associated with vasospasm (all P < 0.05). In the first nationwide analysis of cerebral vasospasm, risk factors included younger age, female sex, smoking history, hemodynamic compromise, and clinical severity of aSAH. Recently proposed biomarkers, including leukocytosis and hypokalemia, were supported by our findings. This study may assist risk stratification and earlier detection of vasospasm.

Hyponatremia as predictor of symptomatic vasospasm in aneurysmal subarachnoid hemorrhage

BackgroundSubarachnoid hemorrhage is one of high morbidity in vascular neurology and neurosurgery and one of the clipart for this is symptomatic vasospasm that can leads to delayed cerebral ischemia. Other common complication is electrolytes and fluid homeostasis disturbance and among these, is Sodium disequilibrium, either hypo- or hypernatremia. In our institution we observed that hyponatremia is common, and it is more evident in patient with symptomatic vasospasm. For that we retrospectively looked at the association of hyponatremia and the occurrence of symptomatic vasospasm or delayed cerebral ischemia in aSAH. MethodsRetrospective chart review with daily monitoring of sodium level from day 1to day 21 from the ictus, aSAH. We include all adult patients (Age > 18 years) who were admitted to intensive care with diagnosis of aSAH and undergone aneurysm securing procedures within 48 h. ResultsAmong 45 patients 24 (43%) developed symptomatic vasospasm and delayed cerebral ischemia and it was most common in males (13/22: 59%). Sodium level especially hyponatremia in period between days (1–4) with median of 134 in vasospasm group (50%). ConclusionsDelayed cerebral ischemia/symptomatic vasospasm occurs more commonly in males and associated with hyponatremia (Na+ <134) and can be predicted in the first 4 days.

Systematic Review of Intrathecal Nicardipine for the Treatment of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage.

Intrathecal nicardipine has been shown to have some efficacy for the treatment of symptomatic cerebral vasospasm in aneurysmal subarachnoid hemorrhage (aSAH). We performed a PRISMA-based systematic review of intrathecal nicardipine for the treatment of cerebral vasospasm in aneurysmal subarachnoid hemorrhage. A total of 825 articles were reviewed. After duplicates were removed and the search criteria was applied, 9 articles remained that were eligible for inclusion and analysis. 377 patients received a total of 6,596 injections of intrathecal nicardipine for aSAH-related cerebral vasospasm. The cumulative ventriculostomy-associated infection risk was 6%. Intrathecal nicardipine injections for aSAH-related cerebral vasospasm appears efficacious and safe. Administration of 4 mg of nicardipine every 12 hours was the most commonly reported dosing regimen. Intrathecal nicardipine decreases mean flow velocities on transcranial Doppler and reduces angiographic and clinical vasospasm. The infection risk appears to be in-line with studies in which rates of EVD-related infections have been reported.

The Rise and Fall of Transcranial Doppler Ultrasonography for the Diagnosis of Vasospasm in Aneurysmal Subarachnoid Hemorrhage.

The Rise and Fall of Transcranial Doppler Ultrasonography for the Diagnosis of Vasospasm in Aneurysmal Subarachnoid Hemorrhage.

Cerebral Artery Vasospasm Detection Using Transcranial Doppler Signal Analysis.

Silent cerebral artery vasospasm in aneurysmal subarachnoid hemorrhage causes serious complications such as cerebral ischemia and death. A transcranial Doppler (TCD) ultrasound system is a noninvasive device that can effectively detect cerebral artery vasospasm as soon as it sets in, even before and in the absence of clinical deterioration. Continuous or even daily TCD monitoring is challenging because of the operator expertise and certification required in the form of a trained sonographer and interpretive experience required in the form of an additionally trained and certified physician to perform these studies. This barrier exists because of a lack of automation for detection (without human intervention) of cerebral artery vasospasm using TCD ultrasound. To overcome this barrier, we present an algorithm that automates detection of cerebral artery vasospasm. We extracted features such as the energy, energy entropy, zero-crossing rate, spectral centroid, spectral speed, spectral entropy, spectral flux, spectral roll-off, harmonic ratio, chroma, and Mel frequency cepstral coefficients for signal classification. Then we applied principal component analysis to reduce the data dimensionality. All of the chosen features were used for training a decision-tree classifier. The algorithm had high accuracy for cerebral artery vasospasm detection, with overall sensitivity of 87.5% and specificity of 89.74%. The algorithm has the potential for development into a continuous cerebral artery vasospasm monitor.

Spinal cerebrospinal fluid drainage for prevention of vasospasm in aneurysmal subarachnoid hemorrhage: A prospective, randomized controlled study

Introduction:Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a major cause of mortality and morbidity. Despite various treatment modalities, the optimal management of vasospasm remains elusive. In this regard; we undertook a prospective, randomized controlled study to evaluate the effectiveness of lumbar cerebrospinal fluid drainage (LCSFD) for prevention of cerebral vasospasm and its sequelae.Materials and Methods:Patients with aneurysmal SAH who met the inclusion criteria were randomized into two groups – Group I (30 patients) underwent LCSFD whereas Group II (30 patients) did not undergo LCSFD. All patients underwent aneurysmal clipping. Both the groups received standard neurosurgical treatment except for LCSFD. The outcome was measured in terms of (1) clinically evident vasospasm; (2) vasospasm-related cerebral infarction; (3) condition of the patient at the time of discharge; and (4) Glasgow outcome score (GOS) at 1- and 3-month follow-up.Results:LCSFD conferred a statistically significant benefit reducing the incidence of clinical vasospasm from 63% (in non-LCSFD group) to 30% (in LCSFD group) (P = 0.01) and incidence of vasospasm-related cerebral infarction from 53% (in non-LCSFD group) to 20% (in LCSFD group) (P = 0.007). Incidence of vasospasm was quantitatively lower in LCSFD group across all Hunt and Hess grades; however, it was statistically significant in SAH Grade III (P = 0.008). Mean duration of hospital stay was slightly lower in LCSFD group compared to non-LCSFD group; however, it did not reach statistical significance. A higher incidence of meningitis in LCSFD group was not statistically significant. A higher GOS was observed in LCSFD group at 1- and 3-month follow-up as compared to non-LCSFD group.Conclusion:Drainage of CSF through a lumbar drain following aneurysmal SAH caused a statistically significant reduction in the incidence of clinical and radiological vasospasm and its sequelae. It also shortens the overall duration of hospital stay and improves the outcome as evidenced by a better GOS score at 1- and 3-month follow-up. The results of this prospective, randomized study establish the efficacy of LCSFD in prevention of vasospasm following aneurysmal SAH.

Success of Intravenous Infusion of Verapamil for Refractory Vasospasm in aneurysmal Subarachnoid Hemorrhage (P2.291)

Success of Intravenous Infusion of Verapamil for Refractory Vasospasm in aneurysmal Subarachnoid Hemorrhage (P2.291)

Variability in Endovascular Treatment of Delayed Cerebral Ischemia and Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Variability in Endovascular Treatment of Delayed Cerebral Ischemia and Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Rescue therapy for refractory vasospasm after subarachnoid hemorrhage.

Vasospasm and delayed cerebral ischemia remain to be the common causes of increased morbidity and mortality after aneurysmal subarachnoid hemorrhage. The majority of clinical vasospasm responds to hemodynamic augmentation and direct vascular intervention; however, a percentage of patients continue to have symptoms and neurological decline. Despite suboptimal evidence, clinicians have several options in treating refractory vasospasm in aneurysmal subarachnoid hemorrhage (aSAH), including cerebral blood flow enhancement, intra-arterial manipulations, and intra-arterial and intrathecal infusions. This review addresses standard treatments as well as emerging novel therapies aimed at improving cerebral perfusion and ameliorating the neurologic deterioration associated with vasospasm and delayed cerebral ischemia.