A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage Part II: Management.
This review examines prevention and treatment of delayed cerebral vasospasm after aneurysm haemorrhage, with emphasis on techniques for removal of cisternal blood, fluid loading and induced hypertension, and calcium antagonists. Most effective were fluids/hypertension and nimodipine, which reduced the incidence of DID by over half. Other drugs that may be useful are tissue plasminogen activator and the aminosteroids. A number of others have also been examined. For the treatment of DID, calcium antagonists, and fluid loading and hypertensive treatment are the most effective. Transluminal angioplasty is also proving to be useful. The combination of prophylaxis and treatment with fluids and nimodipine should reduce poor outcome resulting from vasospasm by two-thirds, from 21% untreated to less than 7%. In spite of the more or less proven efficacy of these measures, large numbers of cases are still being reported in whom no specific management is being used.
Dorsch
N W
NW
Department of Neurosurgery, Westmead Hospital, Sydney, Australia.