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cerebral vasospasm
Etiology:
- cerebral aneurysm rupture
- subarachnoid hemorrhage
- cerebral angiography
Clinical manifestations:
- typically occurs 3-4 days after cerebral hemorrhage
- symptoms generally occur 4-5 days after cerebral hemorrhage
- reaches a peak in severity at 7-10 days [2]
- insidious onset of confusion
- decreasing level of consciousness
- in severe cases
- focal neurological deficits
- cerebral infarction
- coma & death
- in less severe cases, neurological recovery can be expected as the vasospasm resolves
Radiology:
- transcranial Doppler ultrasonography
- increased velocity in the affected arteries (> 200 cm/sec) [3]
- CT angiography [4]
Management:
1) nimodipine 30-60 mg PO every 4 hours for 21 days
- mild volume expansion to minimize effects on systemic blood pressure
2) hypervolemic, hypertensive therapy elevates cerebral perfusion pressure
- surgical clipping a ruptured aneurysm early allows more aggressive therapy with diminished risk of subsequent hemorrhage
- endovascular therapy may be alternative to surgical clipping
- repair of aneurysm should be done within 24-48 hours of diagnosis of subarachnoid hemorrhage due to cerebral aneurysm rupture
3) balloon dilatation of cerebral vasospasm encompasses 3 CPT terms; however, it is not one of the 2 treatments generally accepted to be of substantial value [2]
General
vasospasm
References
- Wikipedia: Cerebral vascospasm
http://en.wikipedia.org/wiki/Cerebral_vasospasm
- Awasthi D
Cerebral Vasospasm. Current Thinking and Future Trends.
Department of Neurosurgery,
Louisiana State University Medical Center
New Orleans, Louisiana
http://www.medschool.lsuhsc.edu/neurosurgery/nervecenter/spasm.html
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022