Risk factors and medical management of vasospasm after subarachnoid hemorrhage

Vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. This article reviews the risk factors for vasospasm; the various methods for diagnosing vasospasm including the conventional 4-vessel angiography, computed tomographic angiography, and computed tomographic perfusion; the methods to detect vasospasm before clinical onset (including transcranial Doppler ultrasonography); and the recent emergence of multimodality monitoring. A discussion of medical treatment options in the setting of vasospasm is also included; the prophylactic use of "neuroprotectants" such as nimodipine, statins, and magnesium and the role of hemodynamic augmentation in vasospasm amelioration, including the use of inotropic support in addition to traditional triple-H therapy, are discussed.