Cerebral Vasospasm: Practical Review of Diagnosis and Management.

Abstract

BACKGROUND Cerebral vasospasm is one of the frequent complications that can occur following subarachnoid hemorrhage (SAH). With new protocols in the management of SAH, the combined risk of death and long-term disability has been reduced by about 10% compared with the past. OBJECTIVE This work aims to report the latest updates on the vasospasm developing after the SAH in patients in the ICU department. In this short review, we reviewed the latest scientific findings on the mechanisms of vasospasm, and, in addition, we considered it necessary to review the literature to report the tools for early diagnosis of vasospasm and the best treatment strategies to prevent the negative outcome in patients admitted to ICU. SCOPE The aim of this narrative review is to report the main characteristics of vasospasm, new diagnostic methods and, especially, more effective treatment of vasospasm. MATERIALS AND METHODS The peer-reviewed articles analyzed were selected from PubMed, google scholar, Embase, Scopus databases in the previous 20 years and using the keywords words "vasospam", "vasospasm diagnosis", "vasospasm and SAH", "vasospasm treatment", non-traumatic brain injury. Among the 78 papers identified, 43 articles were selected; after title - abstract examination and removing the duplicates, only 31 articles were examined. RESULTS Vasospasm can be classified according to clinical (asymptomatic vs symptomatic) and diagnostic (angiographic vs ultrasound) methods. Various procedures such as TCD and CT perfusion are used for early diagnosis and close monitoring of this condition. The treatment of vasospasm consists of both prevention (nimodipine, statitis, magnesium sulphate) and active treatment (mainly endovascular). CONCLUSION As the review shows, vasospasm is a complication of SAH, a complication that is difficult to recognise early and treat with the best outcome. However, with the equipment we have, it has been possible to improve the outcome, even if it is still not ideal, of patients who develop vasospasm. Several studies are in the final stages to improve the outcome of this unfortunately frequent condition.