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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Radiographic Evaluation and Clinical Management of Cerebral Vasospasm
Krishna Amuluru1, Kushal J Shah2, Troy D Payner2
1Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Division of Interventional Neuroradiology, Indianapolis, IN, USA.
Abstract:
Delayed cerebral ischemia (DCI) occurs 3-14 days after aneurysmal subarachnoid hemorrhage (aSAH) and involves secondary neurological deterioration. The term "DCI" is defined as focal neurological impairment lasting >1 hour, unrelated to other causes, and diagnosed via clinical assessment and imaging. Paradigm shifts have taken emphasis away from merely vasospasm towards a pathophysiology related to microcirculatory dysfunction, inflammation, and impaired autoregulation. Clinical examination, multimodality monitoring and various imaging/perfusion imaging aid in detection. Nimodipine remains the only proven treatment to affect outcomes. Endovascular intervention is considered for cases refractory to hemodynamic management, and involves intra-arterial vasodilators, and modern interventional devices.
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