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Cerebral Vasospasm: A Review

  • J. Max Findlay (a1), Joshua Nisar (a1) and Tim Darsaut (a1)

Abstract

Cerebral vasospasm is a prolonged but reversible narrowing of cerebral arteries beginning days after subarachnoid hemorrhage. Progression to cerebral ischemia is tied mostly to vasospasm severity, and its pathogenesis lies in artery encasement by blood clot, although the complex interactions between hematoma and surrounding structures are not fully understood. The delayed onset of vasospasm provides a potential opportunity for its prevention. It is disappointing that recent randomized, controlled trials did not demonstrate that the endothelin antagonist clazosentan, the cholesterol-lowering agent simvastatin, and the vasodilator magnesium sulfate improve patient outcome. Minimizing ischemia by avoiding inadequate blood volume and pressure, administering the calcium antagonist nimodipine, and intervention with balloon angioplasty, when necessary, constitutes current best management. Over the past two decades, our ability to manage vasospasm has led to a significant decline in patient morbidity and mortality from vasospasm, yet it still remains an important determinant of outcome after aneurysm rupture.

Vasospasme cérébral : revue du sujet. Le vasospasme cérébral consiste en un rétrécissement prolongé mais réversible d’une artère cérébrale débutant dans les jours suivant une hémorragie sous-arachnoïdienne (HSA). La progression vers l’ischémie cérébrale est liée surtout à la sévérité du vasospasme et sa pathogenèse est en lien avec le caillot formant une gaine autour de l’artère. Cependant, les interactions complexes entre l’hématome et les structures environnantes demeurent mal connues. Le délai entre l’HSA et le vasospasme fournit une occasion potentielle de prévention. Des essais contrôlés randomisés récents n’ont pas démontré que le clazosentan, un antagoniste de l’endothéline, la simvastatine, un hypocholestérolémiant, ou le sulfate de magnésium, un vasodilatateur, améliorent le résultat chez le patient. Actuellement, le meilleur traitement consiste à minimiser l’ischémie en s’assurant que le volume sanguin et la tension artérielle sont adéquats, en administrant de la nimodipine, un antagoniste du calcium, et en procédant à une angioplastie par ballonnet si nécessaire. Au cours des vingt dernières années, une diminution significative de la morbidité et de la mortalité due au vasospasme a été observée grâce à ces moyens de traitement. Cependant le vasospasme demeure un important déterminant de l’issue chez le patient après la rupture d’un anévrisme cérébral.

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Copyright

This is an open access article, distributed under the terms of the creative commons attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to: J. Max Findlay, University of Alberta Hospital, 2D1.02 WMC, 8440 112 Street, Edmonton, AB T6G 2B7. Email: max.findlay@albertahealthservices.ca.

References

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Cerebral Vasospasm: A Review

  • J. Max Findlay (a1), Joshua Nisar (a1) and Tim Darsaut (a1)

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