PREVENTION AND TREATMENT OF CEREBRAL VASOSPASM AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE - A REVIEW
Abstract
Background. Cerebral vasospasm is the most serious complication of subarachnoid hemorrhage. It can be defined as deferred and self-limited condition whose severity is related to the volume, density, prolonged presence and location of subarachnoid blood. Approximately 70% of these patients demonstrate angiographic evidence of vasospasm, and about 50% of them suffer neurological deficits. The purpose of this article is to review recent advances and future perspectives in the prevention and treatment of cerebral vasospasm after aneurismal subarachnoid hemorrhage.
Materials and methods. An extensive literature search through the Medline and Ebsco databases was performed. Original investigations, meta-analyses and reviews from the past 10 years, with accessible full-texts, in the English language, were selected.
Prevention and treatment. The main medical strategy for prevention of vasospasm includes maintenance of normal circulating blood volume and oral Nimodipine. The only therapy currently established for the treatment of cerebral vasospasm is euvolemic-induced hypertension. Percutaneous transluminal angioplasty and/or selective intra-arterial vasodilator therapy are reasonable in patients with symptomatic cerebral vasospasm, particularly in those who are not responding rapidly to hypertensive therapy.
Conclusion. Novel approaches with immunomodulators, anesthetics, hypothermia, acupuncture, neuroprotective agents and multimodal treatment regimens are under active development and hold promise in the treatment of vasospasm in the coming years.
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