Radiographic Evaluation and Clinical Management of Cerebral Vasospasm

Abstract

Delayed cerebral ischemia (DCI) occurs 3-14 days after aneurysmal subarachnoid hemorrhage (aSAH) and involves secondary neurological deterioration. The term "DCI" is defined as focal neurological impairment lasting >1 hour, unrelated to other causes, and diagnosed via clinical assessment and imaging. Paradigm shifts have taken emphasis away from merely vasospasm towards a pathophysiology related to microcirculatory dysfunction, inflammation, and impaired autoregulation. Clinical examination, multimodality monitoring and various imaging/perfusion imaging aid in detection. Nimodipine remains the only proven treatment to affect outcomes. Endovascular intervention is considered for cases refractory to hemodynamic management, and involves intra-arterial vasodilators, and modern interventional devices.

Keywords: Angioplasty; CTA; Cerebral aneurysm; Delayed cerebral ischemia; Intra-arterial vasodilators; Magnetic resonance angiography; Perfusion; Subarachnoid hemorrhage; Vasospasm.