Risk factors and medical management of vasospasm after subarachnoid hemorrhage.
Vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. This article reviews the risk factors for vasospasm; the various methods for diagnosing vasospasm including the conventional 4-vessel angiography, computed tomographic angiography, and computed tomographic perfusion; the methods to detect vasospasm before clinical onset (including transcranial Doppler ultrasonography); and the recent emergence of multimodality monitoring. A discussion of medical treatment options in the setting of vasospasm is also included; the prophylactic use of "neuroprotectants" such as nimodipine, statins, and magnesium and the role of hemodynamic augmentation in vasospasm amelioration, including the use of inotropic support in addition to traditional triple-H therapy, are discussed.
Lazaridis
Christos
C
Department of Neurology, Neurosciences Intensive Care Unit, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 428, Charleston, SC 29425, USA. lazaridi@musc.edu
Naval
Neeraj
N
D002533:Cerebral Angiography / Q000379:methods / Q000639:trends; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003952:Diagnostic Imaging / Q000379:methods* / Q000639:trends; D006801:Humans; D018696:Neuroprotective Agents / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000639:trends; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy
D018696:Neuroprotective Agents