title: Hyperacute Vasospasm After Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Cerebral vasospasm after aneurysmal subarachnoid hemorrhage typically occurs 3-14 days after aneurysm rupture. We describe a series of patients who developed vasospasm within minutes of aneurysm rupture. This phenomenon, which we term, "hyperacute vasospasm," has been reported in animal models of SAH, but hitherto has been poorly described in humans.
  
  
  METHODS
  Eleven patients were identified from an institutional registry who had aneurysmal rupture during catheter cerebral angiography between 1997 and 2009. We quantified the degree of vasoconstriction using vascular diameter index (VDI). The change in VDI (delta VDI or DVDI) was calculated by determining the difference in VDI before and after the procedure. We also examined the relationship between hyperacute vasospasm and delayed cerebral ischemia.
  
  
  RESULTS
  Ten of eleven (91%) patients with intraoperative aneurysm rupture had cerebral vasoconstriction within minutes of intra-procedural aneurysmal rupture. Six of eleven patients (55%) with hyperacute vasospasm developed delayed cerebral infarction.
  
  
  CONCLUSIONS
  Hyperacute vasospasm is likely common in patients with intraoperative aneurysm rupture and may be an unrecognized element of the natural history of aneurysmal subarachnoid hemorrhage. In this limited series, there was an association between hyperacute vasospasm and delayed cerebral infarction.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.|Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Bar
authors.affiliation: Department of Neurology, Abington Memorial Hospital, Abington, PA, USA.
authors.forename: L
authors.initials: L
authors.lastname: MacKenzie
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Hurst
authors.affiliation: Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA.
authors.forename: R
authors.initials: R
authors.lastname: Grant
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Weigele
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Bhalla
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA.|Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Kumar
authors.affiliation: Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Stiefel
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA. joshua.levine@uphs.upenn.edu.|Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA. joshua.levine@uphs.upenn.edu.|Division of Neurocritical Care, Department of Neurology, Hospital of the University of Pennsylvania, 3 W Gates Pavillion, 3400 Spruce Street, Philadelphia, PA, 19104, USA. joshua.levine@uphs.upenn.edu.
authors.forename: J M
authors.initials: JM
authors.lastname: Levine
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications*; D002533:Cerebral Angiography / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000209:etiology; D020301:Vasospasm, Intracranial / Q000209:etiology*
keywords: Aneurysm rupture; Cerebral vasospasm; Subarachnoid hemorrhage