Radiographic Evaluation and Clinical Management of Cerebral Vasospasm

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Delayed cerebral ischemia (DCI) is a critical complication following aneurysmal subarachnoid hemorrhage (aSAH), occurring 3-14 days post-event.
• DCI is characterized by secondary neurological deterioration, defined as focal neurological impairment lasting over an hour and not attributable to other causes.
• Pathophysiology understanding has evolved from vasospasm to include microcirculatory dysfunction, inflammation, and impaired autoregulation.

Purpose of the Study:

• To summarize the current understanding and management of DCI following aSAH.
• To highlight the shift in pathophysiological concepts and diagnostic approaches.
• To outline treatment strategies for DCI.

Main Methods:

• Review of clinical examination findings.
• Utilization of multimodality monitoring.
• Application of various diagnostic and perfusion imaging techniques.

Main Results:

• Nimodipine is the sole medication proven to improve outcomes in DCI.
• Endovascular interventions are reserved for refractory cases unresponsive to hemodynamic management.
• Treatment modalities include intra-arterial vasodilators and advanced interventional devices.

Conclusions:

• DCI management requires a comprehensive approach integrating clinical assessment, monitoring, and advanced imaging.
• The understanding of DCI pathophysiology has broadened, necessitating a multi-faceted treatment strategy.
• While nimodipine is standard, endovascular options offer alternatives for complex cases.