title: To look beyond vasospasm in aneurysmal subarachnoid haemorrhage.
abstract: Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed.
authors: Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Faculty of Human Medicine and Biology, Lausanne University, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors: Giulia
authors: 0000-0003-0913-8965
authors: G
authors: Cossu
authors: Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Faculty of Human Medicine and Biology, Lausanne University, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors: Mahmoud
authors: M
authors: Messerer
authors: Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Faculty of Human Medicine and Biology, Lausanne University, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors: Mauro
authors: M
authors: Oddo
authors: Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Faculty of Human Medicine and Biology, Lausanne University, rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors: Roy Thomas
authors: RT
authors: Daniel
mesh_terms: D002545:Brain Ischemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D020301:Vasospasm, Intracranial / Q000401:mortality / Q000503:physiopathology / Q000628:therapy