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Cerebral vasospasm

Cerebral vasospasm is a condition in which the blood vessels in the brain narrow, thereby reducing blood flow to the brain and subsequent death of brain tissue. The typical vessels involved are those in the Circle of Willis, an area at the base of the brain that connects the large arteries in the brain to each other.

subarachnoid hemmorhage

Subarachnoid Hemorrhage from
Ruptured Aneurysm
 

Cause

This condition usually occurs in patients after a subarachnoid hemorrhage, a type of brain bleed that is usually caused by a ruptured aneurysm. Up to 75% of patients surviving a subarachnoid hemorrhage go on to develop cerebral vasospasm, however only 30% of these are symptomatic in the form of brain deficits.

Symptoms

Typically, the patients present with symptoms 3 to 14 days after the initial subarachnoid hemorrhage but it can occur up to 3 weeks with the greatest risk at 7 days. 

Diagnosis

To diagnose cerebral vasospasm, a physician may use transcranial dopplers, CT-angiography, MR-angiography, or may obtain a cerebral angiogram. Although the direct cause of the disease is largely unknown, it is thought that is caused by an imbalance in the chemicals that cause vasoconstriction (blood vessel narrowing) and vasodilation (blood vessel widening). 

Treatment

Most patients with subarachnoid hemorrhages are given drugs to prevent strokes from cerebral vasospasm.  Once the disease is diagnosed, the treatment options elevation of blood pressure to force blood perfusion to the brain, and/or treatment through angiography.  Through angiography, a physician can deliver medicine to the arteries, and/or use balloon angioplasty to dilate the arteries, depending on the severity and location of the vasospasm.

Kevin White, Justin F. Fraser, MD 

References

Goldman. (2011).  Goldman's Cecil Medicine, 24th ed. Sanders.  Philadelphia: PA.

Bradley, (2008) Neurology in Clinical Practice, 5th ed.  Butterworth-Heinemann, Philadelphia: PA.

Stroke and cerebrovascular disorders » 

Page last updated: 6/20/2014 2:40:29 PM