"After decades of research, the exact mechanism(s) responsible remains elusive 12 although a number of candidate agents are demonstrated to play a role. These include:"
"In addition to imaging vascular stenosis directly with CTA (see above) CT perfusion can be used identify vasospasm with fairly high sensitivity (85.6%) and specificity (87.9%) 15. CT angiography compared with catheter angiography shows a sensitivity of 82% and specificity of 97%, with lower accuracy for medium and small vessels, susceptibility to artifactss and overestimation of arterial narrowing 16."
"within 3 days status post-SAH"
"serotonin (5-HT)"
"traditionally, Haemodilution, Hypertension, Hypervolaemia to maintain adequate cerebral perfusion pressure was advocated with hydration and inotropes"
"traditionally, Haemodilution, Hypertension, Hypervolaemia to maintain adequate cerebral perfusion pressure was advocated with hydration and inotropes"
"traditionally, Haemodilution, Hypertension, Hypervolaemia to maintain adequate cerebral perfusion pressure was advocated with hydration and inotropes"
Expected headings
"Angiography"
"Cerebral vasospasm on imaging is more common in aneurysmal SAH (~50%; range 30-70%) than after traumatic brain injury, i.e. traumatic SAH (~20%; range 10-30%) or blast-related injury 1,12. It becomes clinically apparent in ~25% of patients, typically from the 4th to 10th day post bleed 1."
"Cerebral vasospasm on imaging is more common in aneurysmal SAH (~50%; range 30-70%) than after traumatic brain injury, i.e. traumatic SAH (~20%; range 10-30%) or blast-related injury 1,12. It becomes clinically apparent in ~25% of patients, typically from the 4th to 10th day post bleed 1."
"Transcranial Doppler (TCD) is used as a screening modality for vasospasm after SAH; it relies on the use of pulsed wave Doppler to determine the velocity of blood flow in the middle cerebral artery (MCA). The following have been suggested to be supportive of the presence of vasospasm in a suggestive clinical context 11:"
"Vasospasm associated with subarachnoid haemorrhage is usually characterised by diffuse narrowing without intervening regions of normal vessel calibre 10 and can be assessed using CTA, MRA or catheter angiography. The secondary effects of vasospasm (e.g. delayed cerebral ischaemia) can be imaged with CT and MR and is discussed separately."
"Aggressive, early and prophylactic treatment can markedly reduce the incidence of vasospasm but often requires early securing of the ruptured aneurysm. Three main modalities are employed:"