title: Rescue therapy for refractory vasospasm after subarachnoid hemorrhage.
abstract: Vasospasm and delayed cerebral ischemia remain to be the common causes of increased morbidity and mortality after aneurysmal subarachnoid hemorrhage. The majority of clinical vasospasm responds to hemodynamic augmentation and direct vascular intervention; however, a percentage of patients continue to have symptoms and neurological decline. Despite suboptimal evidence, clinicians have several options in treating refractory vasospasm in aneurysmal subarachnoid hemorrhage (aSAH), including cerebral blood flow enhancement, intra-arterial manipulations, and intra-arterial and intrathecal infusions. This review addresses standard treatments as well as emerging novel therapies aimed at improving cerebral perfusion and ameliorating the neurologic deterioration associated with vasospasm and delayed cerebral ischemia.
authors.affiliation: Department of Neurology and Neurocritical Care, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, CR-127, Portland, OR, 97239, USA, durrantj@ohsu.edu.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Durrant
authors.forename: Holly E
authors.initials: HE
authors.lastname: Hinson
mesh_terms: D017130:Angioplasty; D002533:Cerebral Angiography; D006801:Humans; D007036:Hypothermia, Induced; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D020301:Vasospasm, Intracranial / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*