delayed_cerebral_ischemia

Delayed cerebral ischemia

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).

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

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

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).


1)
Washington CW, Zipfel GJ. Detection and monitor- ing of vasospasm and delayed cerebral ischemia: a review and assessment of the literature. Neurocrit Care. 2011; 15:312–317
2)
Gathier CS, van der Jagt M, van den Bergh WM, Dankbaar JW, Rinkel GJE, Slooter AJC; HIMALAIA Study Group. Slow recruitment in the HIMALAIA study: lessons for future clinical trials in patients with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage based on feasibility data. Pilot Feasibility Stud. 2022 Aug 30;8(1):193. doi: 10.1186/s40814-022-01155-4. PMID: 36042527.
  • delayed_cerebral_ischemia.txt
  • Last modified: 2022/08/31 09:42
  • by administrador