Cerebral vasospasm after subarachnoid hemorrhage.

Area of Science:

• Neuroscience
• Neurology
• Critical Care Medicine

Background:

• Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of secondary brain injury.
• Pathophysiology involves complex interactions of free radicals, hemoglobin, endothelins, and kinase pathways.
• Microvascular dysfunction and impaired autoregulation are critical research areas.

Purpose of the Study:

• To summarize recent pathophysiologic insights into cerebral vasospasm post-aSAH.
• To review advances in the diagnosis of cerebral vasospasm.
• To highlight novel and emerging treatment strategies for vasospasm and its complications.

Main Methods:

• Review of recent literature on cerebral vasospasm pathophysiology, diagnosis, and treatment.
• Identification of new mediators, diagnostic tools, and therapeutic agents.
• Analysis of evolving clinical practices, including interventional procedures.

Main Results:

• Key mediators identified include superoxide radicals, ferrous hemoglobin, endothelins, protein kinase C, and rho kinase.
• Advanced diagnostics include advanced imaging (SPECT, perfusion CT, MRI) and monitoring (intracranial oxygen, jugular venous saturation).
• Emerging treatments include magnesium sulfate, fasudil hydrochloride, tirilazad mesylate, erythropoietin, induced hypothermia, and balloon angioplasty.

Conclusions:

• Neurointensive care for vasospasm has significantly advanced with new diagnostics and treatments.
• Balloon angioplasty is increasingly used for refractory vasospasm, even prophylactically.
• Further clinical trials are essential to validate new techniques and optimize management strategies.