Vasospasm
Cerebral vasospasm development is a complex process that remains as one of the most detrimental after-effects of subarachnoid hemorrhage (SAH). SAH is the exposure of blood in the subarachnoid space that can result from a number of physiologic processes, such as ruptured cerebral aneurysms and hemorrhagic tumors. Cerebral vasospasm is defined as the vascular spasm and subsequent narrowing following exposure of the outside wall of cerebral vasculature to blood (1).
This narrowing can lead to several adverse effects, the worst being delayed cerebral ischemia and potential stroke. Over 30% of patients with ruptured aneurysms develop delayed cerebral ischemia and decreased neurologic status, meaning vasospasm is a prevalent condition that needs to be detected swiftly (2).
1) Findlay, J. M., Nisar, J., & Darsaut, T. (2016). Cerebral Vasospasm: A Review. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 43(1), 15–32. https://doi.org/10.1017/cjn.2015.288
2) Dorsch, N. W., & King, M. T. (1994). A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage Part I: Incidence and effects. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 1(1), 19–26. https://doi.org/10.1016/0967-5868(94)90005-1
Current Clinical Pathways
Current methods of vasospasm detection involve a number of imaging modalities. Namely, prevalent techniques include Digital Subtraction Angiography, Computed Tomography Angiography and Computed Tomography Perfusion scans. In addition, a less invasive method included Transcranial Doppler; however, this method is considered less accurate than the aforementioned modalities. Furthermore, delayed cerebral ischemia may be detected with neurological exams.
Once detected, vasospasm is either treated with vasodilating medications or surgically with balloon angioplasty and stents (1).
1) Bauer AM, Rasmussen PA. Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol. 2014 May 20;5:72. doi: 10.3389/fneur.2014.00072. PMID: 24904517; PMCID: PMC4032992.