delayed_cerebral_ischemia_after_aneurysmal_subarachnoid_hemorrhage

Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Failure of cerebral autoregulation has been shown in patients with aSAH even before vasospasm sets in and contributes to delayed ischemic neurological deficits (DIND) along with vasospasm 1).

Delayed ischemic neurological deficit (DIND) due to symptomatic vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH), most likely because of a decreased availability of nitric oxide (NO) in the cerebral microcirculation 2).

The VASOGRADE: is a Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage 3).

Intracerebral hematoma (ICH) was associated with an increased risk of DCI. Furthermore, adding the presence or absence of ICH to the modified Fisher Scale (mFS) improved the identification of patients at the highest risk for the development of DCI. Thus, a simple adjustment of the mFS might help to identify patients at high risk for DCI 4).

see Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage pathophysiology.

Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage prevention

Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage treatment

Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage outcome.

Fifty-seven of 176 prospectively studied patients with aneurysmal subarachnoid hemorrhage (SAH) developed delayed cerebral ischemia. Clinical features included hemispheric focal signs (13), decrease in level of consciousness (14), or both (30), and mutism (15). Forty-seven patients showed hypodense lesions on CT in one (19) or multiple vascular territories (22), or diffusely in one or both hemispheres (6). Twenty-eight had symmetric decrease in ventricular size. Of 18 autopsied patients, only 1 had a purely univascular lesion. The clinical, CT, and pathologic features suggest that delayed cerebral ischemia after SAH is a multivascular or diffuse process in most patients 5).


1)
Sriganesh K, Venkataramaiah S. Concerns and challenges during anesthetic management of aneurysmal subarachnoid hemorrhage. Saudi J Anaesth. 2015 Jul-Sep;9(3):306-13. doi: 10.4103/1658-354X.154733. Review. PubMed PMID: 26240552; PubMed Central PMCID: PMC4478826.
2)
Ehlert A, Schmidt C, Wölfer J, Manthei G, Jacobs AH, Brüning R, Heindel W, Ringelstein EB, Stummer W, Pluta RM, Hesselmann V. Molsidomine for the prevention of vasospasm-related delayed ischemic neurological deficits and delayed brain infarction and the improvement of clinical outcome after subarachnoid hemorrhage: a single-center clinical observational study. J Neurosurg. 2016 Jan;124(1):51-8. doi: 10.3171/2014.12.JNS13846. Epub 2015 Jul 10. PubMed PMID: 26162034.
3)
de Oliveira Manoel AL, Jaja BN, Germans MR, Yan H, Qian W, Kouzmina E, Marotta TR, Turkel-Parrella D, Schweizer TA, Macdonald RL; SAHIT collaborators. The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Stroke. 2015 Jul;46(7):1826-31. doi: 10.1161/STROKEAHA.115.008728. Epub 2015 May 14. PubMed PMID: 25977276.
4)
Platz J, Güresir E, Wagner M, Seifert V, Konczalla J. Increased risk of delayed cerebral ischemia in subarachnoid hemorrhage patients with additional intracerebral hematoma. J Neurosurg. 2017 Feb;126(2):504-510. doi: 10.3171/2015.12.JNS151563. PubMed PMID: 26967776.
5)
Hijdra A, Van Gijn J, Stefanko S, Van Dongen KJ, Vermeulen M, Van Crevel H. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. Neurology. 1986 Mar;36(3):329-33. doi: 10.1212/wnl.36.3.329. PMID: 3951698.
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