cerebral vasospasm

Etiology

• cerebral aneurysm rupture
• subarachnoid hemorrhage
• cerebral angiography

Clinical manifestations

• typically occurs 3-4 days after cerebral hemorrhage
• symptoms generally occur 4-5 days after cerebral hemorrhage
• reaches a peak in severity at 7-10 days
• insidious onset of confusion
• decreasing level of consciousness
• in severe cases
  • focal neurological deficits
  • cerebral infarction
  • coma & death
• in less severe cases, neurological recovery can be expected as the vasospasm resolves

Radiology

• transcranial Doppler ultrasonography
  • increased velocity in the affected arteries (> 200 cm/sec)
• CT angiography

Management

• nimodipine 30-60 mg PO every 4 hours for 21 days
  • mild volume expansion to minimize effects on systemic blood pressure
• hypervolemic, hypertensive therapy elevates cerebral perfusion pressure
  • surgical clipping a ruptured aneurysm early allows more aggressive therapy with diminished risk of subsequent hemorrhage
  • endovascular therapy may be alternative to surgical clipping
  • repair of aneurysm should be done within 24-48 hours of diagnosis of subarachnoid hemorrhage due to cerebral aneurysm rupture
• balloon dilatation of cerebral vasospasm encompasses 3 CPT terms; however, it is not one of the 2 treatments generally accepted to be of substantial value

More general terms

• vasospasm