Delayed-cerebral ischemia is a major cause of morbidity and mortality in the setting of aneurysmal subarachnoid hemorrhage. Despite extensive research efforts and a breadth of collective clinical experience, accurate diagnosis of vasospasm remains difficult, and effective treatment options are limited. Classically, diagnosis has focused on imaging assessment of the cerebral vasculature. Recently, invasive and noninvasive bedside techniques designed to characterize relevant hemodynamic and metabolic alterations have gained substantial attention. Such modalities include microdialysis, brain tissue oxygenation, jugular bulb oximetry, thermal diffusion cerebral blood flow, and near-infrared spectroscopy. This paper reviews these modalities and examines data pertinent to the diagnosis and management of cerebral vasospasm. 1. Introduction Delayed-cerebral ischemia (DCI) is a major cause of morbidity and mortality in the setting of aneurysmal subarachnoid hemorrhage (aSAH) [1]. Early diagnosis and effective treatment of cerebral vasospasm remain considerable challenges. Neurologists, neurosurgeons, and intensivists utilize multiple advanced diagnostic imaging techniques and examine a broad spectrum of physiologic parameters in attempts to identify reversible cerebral ischemia following aSAH. These modalities provide important data that guide treatment decisions and influence management protocols. Nonetheless, vasospasm related morbidity and mortality remain exceedingly high. Over the past twenty years, efforts have centered on identifying metabolic substrates relevant to the pathogenesis of cerebral vasospasm. As a result, intracerebral monitoring has given rise to a new, multimodal discipline providing specialists, a wide a variety of novel biomarkers potentially relevant to the diagnosis and management of delayed cerebral ischemia. This paper reviews both invasive and noninvasive multimodal bedside monitoring strategies and examines data pertinent to the diagnosis and management of cerebral vasospasm. 2. Methods An extensive literature search through PubMed medical database through July 2012 was conducted using combinations of the keywords “aneurysmal subarachnoid hemorrhage,” “vasospasm,” “microdialysis,” “brain tissue oxygenation (Licox, Integra Neurosciences),” “jugular bulb oximetry,” “thermal diffusion cerebral blood flow (Hemedex, Hemedex Inc.),” and “near-infrared spectroscopy.” All titles and abstracts identified were reviewed. Additional articles were identified from the reference lists of the selected manuscripts. Articles in all languages were
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