Cerebral vasospasm in subarachnoid hemorrhage

Alejandro Rabinstein, Eelco F.M. Wijdicks

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

The treatment of vasospasm after subarachnoid hemorrhage remains a formidable challenge. The prompt recognition of this complication is essential to prevent ischemic damage. Initial orders should include adequate fluid and sodium supplementation to avoid volume depletion. Prophylactic hypervolemia is not effective in reducing the incidence of vasospasm and may be deleterious. Oral nimodipine (60 mg every 4 hours for 21 days) should be started on admission because it protects against delayed ischemic damage. Increasing blood flow velocities on serial transcranial Doppler studies are reliable indicators of early development of vasospasm. When symptomatic vasospasm occurs, hemodynamic augmentation therapy should be instituted. Crystalloids and colloids may be used to promote hypervolemia. Colloids may provide additional benefit by producing hemodilution. However, the rheological benefits of hemodilution may be offset by reduced oxygen carrying capacity when hematocrit drops below 28%. Hypertension may be induced by administering inotropic drugs and, in certain cases, cardiac output optimization using dobutamine also is necessary. When aggressive medical therapy fails to reverse ischemic deficits, prompt endovascular intervention is indicated. Focal vasospasm of larger vessels may be effectively treated with angioplasty and the benefits of this procedure are durable. Diffuse vasospasm involving smaller arterial branches may be treated with intra-arterial infusion of vasodilators, such as papaverine, verapamil, or nicardipine. Unfortunately, these dilatory effects tend to be short-lasting. In refractory cases, hypothermia may be considered, although value of this strategy remains largely unexplored.

Original languageEnglish (US)
Pages (from-to)99-107
Number of pages9
JournalCurrent Treatment Options in Neurology
Volume7
Issue number2
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Intracranial Vasospasm
Subarachnoid Hemorrhage
Hemodilution
Colloids
Nicardipine
Intra Arterial Infusions
Nimodipine
Papaverine
Dobutamine
Blood Flow Velocity
Conservation of Natural Resources
Verapamil
Hypothermia
Vasodilator Agents
Angioplasty
Hematocrit
Cardiac Output
Therapeutics
Hemodynamics
Sodium

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Cerebral vasospasm in subarachnoid hemorrhage. / Rabinstein, Alejandro; Wijdicks, Eelco F.M.

In: Current Treatment Options in Neurology, Vol. 7, No. 2, 01.01.2005, p. 99-107.

Research output: Contribution to journalReview article

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