Time course of vasospasm in man

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Subarachnoid hemorrhage (SAH) is a critical condition often leading to delayed cerebral vasospasm.
• Cerebral vasospasm significantly impacts patient outcomes and mortality following SAH.
• Quantifying vasospasm progression is crucial for understanding its clinical significance.

Purpose of the Study:

• To investigate the temporal profile of cerebral vasospasm after subarachnoid hemorrhage.
• To correlate the severity of vasospasm with clinical grades and patient mortality.

Main Methods:

• Analysis of 627 angiograms from 293 patients with aneurysms.
• Calculation of a vessel diameter ratio in the subarachnoid space versus the base of the skull and neck.
• Plotting the vasospasm ratio over time post-subarachnoid hemorrhage.

Main Results:

• Cerebral vasospasm onset observed around Day 3 after SAH.
• Vasospasm reached maximal severity between Days 6 and 8.
• Vasospasm resolved by Day 12.
• Patients with poorer clinical grades exhibited a greater tendency for vasospasm.
• Higher vasospasm severity correlated with significantly increased mortality.

Conclusions:

• Cerebral vasospasm follows a predictable temporal pattern after SAH.
• Clinical grade is a predictor of vasospasm severity.
• Severe vasospasm is associated with a worse prognosis and higher mortality rates in SAH patients.