Correction and monitoring of postoperative cerebral vasospasm

There have been several case reports in which various hypertension-inducing regimens have been used in the treatment of postoperative cerebral vasospasm. Regimens have included the used of metaraminal bitarate, norepinephrine with intravascular volume expansion, and high-dose dopamine with mannitol and volume expansion. Clinical response has been very favorable. Our patient improved markedly after administration of dopamine and intravascular volume expansion. Little work has been done to document vasospasm as the cause of the ischemia or to demonstrate increased cerebral blood flow following treatment. We suggest that noninvasive Doppler flow velocity studies may be an ideal tool for the further assessment of these patients.