Axial MRI at the level of the medulla of Right PICA distribution infarcts from cerebral vasospasm in the setting of subarachnoid hemorrhage.
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Cerebral Vasospasm
Cerebral Vasospasm
Incidence
- Occurs in roughly 30% of patients with subarachnoid hemorrhage.
Timing
- The hemorrhage triggers cerebral vasospasm 3-14 days post hemorrhage.
Pathogenesis
- Cerebrovasospasm is a spastic narrowing a cerebral blood vessel, causing ischemia/infarct.
Morbidity/Morality
- It is a cause of death or disability in roughly 25% of affected patients.
Management
- Key Management is "HHH" Therapy:
- "Hypervolemia" to produce "Hypertension" and "Hemodilution" via nicardipine and high rate intravenous fluids.
- Balloon angioplasty is employed when necessary to directly open spastic vessels.