Delayed cerebral ischemia
Definition
Delayed development of a neurological deficit, decline in Glasgow coma scale of at least 2 points, and/or cerebral infarction unrelated to aneurysm treatment or other causes. DCI is an umbrella term that encompasses a number of clinical entities including symptomatic vasospasm, delayed ischemic neurological deficit (DIND), and asymptomatic delayed cerebral infarction 1).
Etiology
Delayed cerebral ischemia (DCI) is the most consequential secondary insult after aneurysmal subarachnoid hemorrhage (SAH). It is a multifactorial process caused by a combination of the large artery vasospasm and microcirculatory dysregulation. Despite numerous efforts, no effective therapeutic strategies are available to prevent DCI. Follows some cases of SAH (usually), trauma, or other insults
Prediction
Pathogenesis
Diagnosis
Complications
delayed cerebral ischemia (DCI) which can produce delayed ischemic neurologic deficit (DIND), usually attributed to vasospasm. Typically does not occur until several days following SAH
Prevention
Treatment
Outcome
Clinical trials
Enrolling patients in a randomized trial on a treatment strategy for DCI proved unfeasible: only 1 out of 25 admitted and 1 out of 14 eligible patients could eventually be randomized. These rates, caused by a large proportion of ineligible patients, a small proportion of patients providing informed consent, and a large proportion of patients with contraindications for treatment, can be used to make sample size calculations for future randomized trials in DCI or otherwise critically ill patients. Facilitating informed consent through improved provision of information on risks, possible benefits, and study procedures may result in improved enrolment 2).