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Axial MRI at the level of the medulla of Right PICA distribution infarcts from cerebral vasospasm in the setting of subarachnoid hemorrhage.
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Axial DWI MRI images highlight the Right PICA distribution infarcts.
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Axial MRI at the level of the pons of Right PICA distribution infarcts from cerebral vasospasm in the setting of subarachnoid hemorrhage.
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Axial DWI MRI images highlight the Right PICA distribution infarcts.
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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.
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