Cerebral vasospasm after subarachnoid hemorrhage

  title={Cerebral vasospasm after subarachnoid hemorrhage},
  author={Nazli A Janjua and Stephan A. Mayer},
  journal={Current Opinion in Critical Care},
Purpose of reviewTo summarize new pathophysiologic insights and recent advances in the diagnosis and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Recent findingsImportant, newly recognized mediators of cerebral arterial spasm after subarachnoid hemorrhage include superoxide free radicals, ferrous hemoglobin (which acts as a nitric oxide scavenger), endothelins, protein kinase C, and &rgr; kinase. Microvascular dysfunction and autoregulatory failure also has been an… 

Milrinone and Homeostasis to Treat Cerebral Vasospasm Associated with Subarachnoid Hemorrhage: The Montreal Neurological Hospital Protocol

A protocol using intravenous milrinone, and the maintenance of homeostasis is simple to use and requires less intensive monitoring and resources than the standard triple H therapy.

Progress Reviews Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Rheological or hemodynamic manipulations to prevent or reverse ischemic consequences of vasospasm are relatively effective, but complicated and hazardous, and should be viewed principally as interim measures awaiting development of more specific therapies for the arterial narrowing.

Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: An Overview of Pharmacologic Management

The pathophysiology of vasospasm is poorly understood, which directly contributes to the inconsistency of management and creates a formidable challenge in clinical practice.

Cerebral Vasospasm After Subarachnoid Hemorrhage: An Update

  • Toni Kosty
  • Medicine
    Critical care nursing quarterly
  • 2005
The current body of knowledge as it pertains to vasospasm is reviewed, the direction of ongoing research is outlined, and the future prospects of treatment and diagnosis are outlined.

Evaluation and Management of Cerebral Vasospasm after Subarachnoid Hemorrhage

Cerebral vasospasm following subarachnoid haemorrhage is looked at, including its causes, epidemiology, evaluation, and, most importantly, management.

Advanced Imaging Modalities in the Detection of Cerebral Vasospasm

Both anatomical and physiological imaging modalities applicable to post-SAH vasospasm are examined and a historical background is offered.

Preconditioning effect on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage.

This retrospective case-control study suggests that endogenous protective mechanisms against cerebral vasospasm-a preconditioning effect-may exist in humans, although these results could be the effect of atherosclerosis or some combination of preconditionsing and Atherosclerosis.

Magnesium infusion for vasospasm prophylaxis after subarachnoid hemorrhage.

Analysis of the results suggests that MgSO4 infusion may have a role in cerebral vasospasm prophylaxis if therapy is initiated within 48 hours of aneurysm rupture.

Bilirubin Oxidation Products (BOXes) and Their Role in Cerebral Vasospasm after Subarachnoid Hemorrhage

  • J. ClarkF. Sharp
  • Medicine
    Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
  • 2006
Recent evidence that BOXes play a role in SAH-induced vasospasm is summarized and either blocking bilirubin formation, inactivating bilirUBin or BOXes, or removing all of the blood clot before vasospasms are potential treatment targets.



Vasospasm After Subarachnoid Hemorrhage: Interest in Diffusion-Weighted MR Imaging

Asymptomatic vasospasm in patients with aneurysmal SAH is studied to assess whether DWI provides predictive markers of silent ischemic lesions and/or progression toward symptomatic ischemia, and whether the apparent diffusion coefficients (ADCs) have a reversibility threshold.

Molecular keys to the problems of cerebral vasospasm.

Progress is being made in identifying the various components in the blood that cause SAH-induced vasospasm and evolving understanding of the underlying molecular mechanism may provide the basis for improved treatment after SAH, especially at the level of the microcirculation.

Magnesium sulfate therapy after aneurysmal subarachnoid hemorrhage.

Administration of high-dose MgSO4 following aneurysmal SAH is safe, and steady Mg++ levels in the range of 4 to 5.5 mg/dl are easily maintained, and there is a trend in which a higher percentage of patients obtained GOS scores of 4 or 5 in the group treated with M gSO4, but the trend did not reach a statistically significant level.

Bedside monitoring of cerebral blood flow in patients with subarachnoid hemorrhage.

Changes of cerebral hemodynamics and oxygenation in patients with cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) might be underestimated if transcranial Doppler sonography (TCD) and

Milrinone for the Treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage: Report of Seven Cases

It is suggested that milrinone was effective and safe for the treatment of cerebral vasospasm after subarachnoid hemorrhage in the patients in this series and holds promise as a clinically advantageous treatment regimen.

Calcium antagonists and vasospasm.

  • F. Meyer
  • Medicine, Psychology
    Neurosurgery clinics of North America
  • 1990

Reversal of Radiographically Impending Stroke with Multiple Intraarterial Papaverine Infusions in Severe Diffuse Cerebral Vasospasm Induced by Subarachnoid Hemorrhage

In some patients, intraarterial infusions of papaverine initiated in the earliest stages of ischemia may exacerbate the radiographic appearance of low-attenuation changes, but may ultimately reverse the evolution of cerebral infarction.

Review of Medical Prevention of Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Problem of Neurointensive Care

This topic review collects the relevant literature on clinical trials investigating prophylactic therapies for cerebral vasospasm in patients with aneurysmal SAH and points out some experimental therapies that may hold promise in future clinical trials to prevent the occurrence of vasospasms.

Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage : a randomized controlled trial.

HV therapy resulted in increased cardiac filling pressures and fluid intake but did not increase CBF or blood volume compared with NV therapy, and prophylactic HV therapy is unlikely to confer an additional benefit.

Diffusion-weighted and perfusion-weighted MR of cerebral vasospasm.

In order to be able to acutely assess and select the patients suspected of suffering from vasospasm ischemia, it is necessary to dispose of a sensitive and specific modality that is able to both detect acutely ischemIA and to exclude other causes of brain dysfunction.