Management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

Abstract

Cerebral vasospasm is a serious complication following aneurysmal subarachnoid
hemorrhage (SAH); it causes delayed cerebral ischemia (DCI) or infarction. Arterial vasospasm
is considered the most common cause of disability and mortality among survivors of aneurysmal
SAH. Monitoring for vasospasm is extremely important starting from the first day following a
hemorrhage. The mechanism of vasospasm is not completely understood, but most data and
studies link the incidence of vasospasm to inflammatory responses secondary to extravasation
of blood into the subarachnoid space. It is essential for critical care teams and health care
providers caring for patients with aneurysmal SAH to understand the clinical presentation and
management of cerebral vasospasm. In our review, we focus on the guidelines for monitoring
and basic management of vasospasm and DCI which include monitoring options, hemodynamic
and endovascular therapy, triggers for intervention, and triggers for treatment de-escalation.