[Vasospasm treatment in intensive care]

Vasopasm is a dreadful complication of SAH associated with an important mortality and morbidity. Therapy begins with adequate monitoring and lines, and prevention of secondary brain injuries. 3-H therapy (hypervolemia--hypertension--hemodilution--hyperdynamism) aims to increase perfusion in ischemia areas. 3-H therapy is associated with systemic complication precluding it's prophylactic use. Calcium antagonists, in particular nimodipine, improve outcome and parenteral route is better than oral administration. Tirilazad seems to improve outcome of severe grades. Numerous experiments are performed with drugs interfering with the biochemical cascade leading to vasospasm, but up to today no drug is used in current clinical practice. Intraaortic balloon is still considered as experimental and may have a role in patients presenting with concomitant cardiac failure. Invasive radiology must be considered in vasospasm not improving with standard therapies. Vasopasm is a dire complication after SAH. Support and specific therapies allow a 3-fold reduction in morbidity associated with vasospasm. Vasospasm is a vital emergency, and intervention has to be quick and aggressive.