%0 Journal Article
%T Current Controversies in the Prediction, Diagnosis, and Management of Cerebral Vasospasm: Where Do We Stand?
%A Young Lee
%A Scott L. Zuckerman
%A J. Mocco
%J Neurology Research International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/373458
%X Aneurysmal subarachnoid hemorrhage occurs in approximately 30,000 persons in the United States each year. Around 30 percent of patients with aneurysmal subarachnoid hemorrhage suffer from cerebral ischemia and infarction due to cerebral vasospasm, a leading cause of treatable death and disability following aneurysmal subarachnoid hemorrhage. Methods used to predict, diagnose, and manage vasospasm are the topic of recent active research. This paper utilizes a comprehensive review of the recent literature to address controversies surrounding these topics. Evidence regarding the effect of age, smoking, and cocaine use on the incidence and outcome of vasospasm is reviewed. The abilities of different computed tomography grading schemes to predict vasospasm in the aftermath of subarachnoid hemorrhage are presented. Additionally, the utility of different diagnostic methods for the detection and visualization of vasospasm, including transcranial Doppler ultrasonography, CT angiography, digital subtraction angiography, and CT perfusion imaging is discussed. Finally, the recent literature regarding interventions for the prophylaxis and treatment of vasospasm, including hyperdynamic therapy, albumin, calcium channel agonists, statins, magnesium sulfate, and endothelin antagonists is summarized. Recent studies regarding each topic were reviewed for consensus recommendations from the literature, which were then presented. 1. Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is a relatively rare cause of stroke, occurring in approximately 30,000 persons in the United States each year. However, its impact equals that of cerebral ischemia, the most common cause of stroke, due to its higher morbidity, higher mortality, and occurrence in younger individuals. Approximately 20 to 30 percent of patients with aSAH suffer from cerebral ischemia and infarction due to cerebral vasospasm, which is the number one cause of treatable death and disability following aSAH. Vasospasm occurs most frequently at 7 to 8 days after aSAH and can last for a prolonged period. Clinical vasospasm is defined as a decline in neurologic status due to vasospasm and can result in severe morbidity and mortality. However, clinical vasospasm has also been observed after other invasive and traumatic processes such as craniotomy and traumatic brain injury. The pathogenesis and etiology of this vasospasm are very poorly understood, and treatments to prevent post-SAH vasospasm are widely varied and have greatly different magnitudes of effectiveness. New methods to predict, diagnosis, and manage
%U http://www.hindawi.com/journals/nri/2013/373458/