Hyperacute Vasospasm After Aneurysmal Subarachnoid Hemorrhage.

Area of Science:

• Neurology
• Neurosurgery
• Vascular Medicine

Background:

• Cerebral vasospasm typically manifests 3-14 days post-aneurysmal subarachnoid hemorrhage (SAH).
• This study investigates an unusual presentation of vasospasm occurring immediately after aneurysm rupture, termed "hyperacute vasospasm."
• Previous human data on hyperacute vasospasm following SAH is limited.

Purpose of the Study:

• To describe the phenomenon of hyperacute vasospasm in patients experiencing intraoperative aneurysm rupture.
• To quantify the incidence and characteristics of hyperacute vasospasm.
• To explore the association between hyperacute vasospasm and delayed cerebral ischemia.

Main Methods:

• Retrospective review of eleven patients with intraoperative aneurysm rupture during cerebral angiography (1997-2009).
• Quantification of cerebral vasoconstriction using vascular diameter index (VDI) and change in VDI (DVDI).
• Examination of the relationship between hyperacute vasospasm and subsequent delayed cerebral infarction.

Main Results:

• Hyperacute vasospasm was identified in 10 out of 11 (91%) patients immediately following intraoperative aneurysm rupture.
• Delayed cerebral infarction occurred in 6 out of 11 (55%) patients who experienced hyperacute vasospasm.
• The study quantified vasoconstriction using VDI and DVDI to assess the severity of vasospasm.

Conclusions:

• Hyperacute vasospasm appears to be a common occurrence in patients with intraoperative aneurysm rupture.
• This rapid vasospasm may represent an underrecognized aspect of aneurysmal subarachnoid hemorrhage natural history.
• A potential association exists between hyperacute vasospasm and the development of delayed cerebral infarction.