Cerebral Vasospasm
Axial MRI at the level of the medulla of Right PICA distribution infarcts from cerebral vasospasm in the setting of subarachnoid hemorrhage.

Cerebral Vasospasm

Cerebral Vasospasm
Incidence
  • Occurs in roughly 30% of patients with subarachnoid hemorrhage.
Timing
  • The hemorrhage triggers cerebral vasospasm 3-14 days post hemorrhage.
Pathogenesis
  • Cerebrovasospasm is a spastic narrowing a cerebral blood vessel, causing ischemia/infarct.
Morbidity/Morality
  • It is a cause of death or disability in roughly 25% of affected patients.
Management
  • Key Management is "HHH" Therapy:
    • "Hypervolemia" to produce "Hypertension" and "Hemodilution" via nicardipine and high rate intravenous fluids.
  • Balloon angioplasty is employed when necessary to directly open spastic vessels.