[Cerebral vasospasm after subarachnoid hemorrhage. Current possibilities of prevention and treatment].
Cerebral vasospasm is a complication diagnosed in angiography among about 2/3 of patients after subarachnoid haemorrhage with ruptured cerebral aneurysm. In half of the cases it appears in disturbances of consciousness, neurological deficits and vegetative disturbances. It's final result can be ischemic stroke. Among patients with symptomatic cerebral vasospasm around 1/3 fully recover in 1/3 of cases persistent neurological deficit remains and 1/3 of the patients die. Authors basing on literature and taking into consideration their own experience, reviewed and estimated current methods of prevention and treatment of cerebral vasospasm. Discussed mainly were methods which had been used in every day clinical practice, however some of them still remain controversial. The accepted model of treatment suggests as follows: 1. The exclusion of the aneurysm which was the cause of haemorrhage from the circulation and clot removal from the subarachnoid space; 2. Nimodipine administration; 3. Undertaking hemodynamic treatment; 4. Aminosteroid administration; 5. Performance of angioplasty in the case of lack of reaction to previous types of treatment of cerebral vasospasm.
Stachura
Krzysztof
K
Klinika Neurochirurgii Instytutu Neurologii, Collegium Medicum, Uniwersytetu Jagiellońskiego, 31-503 Kraków.
Danilewicz
Benedykt
B
D017542:Aneurysm, Ruptured / Q000150:complications; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D009553:Nimodipine / Q000627:therapeutic use; D011281:Pregnatrienes / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*
D018696:Neuroprotective Agents; D011281:Pregnatrienes; D014665:Vasodilator Agents; D009553:Nimodipine; D010959:Tissue Plasminogen Activator; C053355:tirilazad