Skip to main content

Advertisement

SpringerLink
Log in

Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage and Traumatic Brain Injury

  • CRITICAL CARE NEUROLOGY (KN SHETH, SECTION EDITOR)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Cerebral vasospasm (cVSP) consists of the vasoconstriction of large and small intracranial vessels which can lead to cerebral hypoperfusion, and in extreme cases, delayed ischemic deficits with stroke. While most commonly observed after aneurysmal subarachnoid hemorrhage (aSAH), cVSP can also occur after traumatic brain injury (TBI) as we have described in detail in this review. For the past decades, the research attention has focused on cVSP because of its association with delayed cerebral ischemia, which is the largest contributor of morbidity and mortality after aSAH. New discoveries in the cVSP pathophysiology involving multifactorial complex cascades and pathways pose new targets for therapeutic interventions in the prevention and treatment of cVSP. The goal of this review is to demonstrate the commonalities and differences in epidemiology and pathophysiology of both aSAH and TBI-associated cVSP, and highlight the more recently discovered pathways of cVSP. Finally, the latest cVSP surveillance methods and treatment options are illustrated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance

  1. Connolly Jr ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke; J Cereb Circul. 2012;43:1711–37These are the most updated AHA guidelines for the care of SAH patients..

    Article  Google Scholar 

  2. Pluta RM. Delayed cerebral vasospasm and nitric oxide: review, new hypothesis, and proposed treatment. Pharmacol Therapeut. 2005;105:23–56.

    Article  CAS  Google Scholar 

  3. Nolan CP, Macdonald RL. Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm? Neurosurg Focus. 2006;21:E1.

    Article  PubMed  Google Scholar 

  4. Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. New England J Med. 2000;342:29–36.

    Article  CAS  Google Scholar 

  5. Rozsa L, Gombi R, Szabo S, Sztermen M. Vasospasm after head injury studied by transcranial Doppler sonography. Radiologia Diagnostica. 1989;30:151–7.

    CAS  PubMed  Google Scholar 

  6. Eisenberg HM, Gary Jr HE, Aldrich EF, et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg. 1990;73:688–98.

    Article  CAS  PubMed  Google Scholar 

  7. Oertel M, Boscardin WJ, Obrist WD, et al. Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg. 2005;103:812–24.

    Article  PubMed  Google Scholar 

  8. Zubkov AY, Lewis AI, Raila FA, Zhang J, Parent AD. Risk factors for the development of post-traumatic cerebral vasospasm. Surgic Neurol. 2000;53:126–30.

    Article  CAS  Google Scholar 

  9. Taneda M, Kataoka K, Akai F, Asai T, Sakata I. Traumatic subarachnoid hemorrhage as a predictable indicator of delayed ischemic symptoms. J Neurosurg. 1996;84:762–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kramer DR, Winer JL, Pease BA, Amar AP, Mack WJ. Cerebral vasospasm in traumatic brain injury. Neurology Research International. 2013;2013:415813.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Servadei F, Murray GD, Teasdale GM, et al. Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries. Neurosurgery. 2002;50:261–7. discussion 7–9.

    PubMed  Google Scholar 

  12. Bell RS, Ecker RD, Severson 3rd MA, Wanebo JE, Crandall B, Armonda RA. The evolution of the treatment of traumatic cerebrovascular injury during wartime. Neurosurg Focus. 2010;28:E5.

    Article  PubMed  Google Scholar 

  13. Armonda RA, Bell RS, Vo AH, et al. Wartime traumatic cerebral vasospasm: recent review of combat casualties. Neurosurgery. 2006;59:1215–25 discussion 25.

    Article  PubMed  Google Scholar 

  14. Arutiunov AI, Baron MA, Majorova NA. The role of mechanical factors in the pathogenesis of short-term and prolonged spasm of the cerebral arteries. J Neurosurg. 1974;40:459–72.

    Article  CAS  PubMed  Google Scholar 

  15. Frontera JA, Fernandez A, Schmidt JM, et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke; J Cereb Circul. 2009;40:1963–8.

    Article  Google Scholar 

  16. Claassen J, Bernardini GL, Kreiter K, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke; J Cereb Circul. 2001;32:2012–20.

    Article  CAS  Google Scholar 

  17. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28:14–20.

    Article  CAS  PubMed  Google Scholar 

  18. Gonzalez NR, Boscardin WJ, Glenn T, Vinuela F, Martin NA. Vasospasm probability index: a combination of transcranial doppler velocities, cerebral blood flow, and clinical risk factors to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2007;107:1101–12.

    Article  PubMed  Google Scholar 

  19. Schmidt JM, Wartenberg KE, Fernandez A, et al. Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage. J Neurosurg. 2008;109:1052–9.

    Article  PubMed  Google Scholar 

  20. Diringer MN, Bleck TP, Claude Hemphill 3rd J, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocritical care. 2011;15:211–40This is a multidisciplinary guideline about the critical care management of SAH with an extensive review of the SAH treatment literature..

    Article  PubMed  Google Scholar 

  21. Rabinstein AA, Friedman JA, Weigand SD, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke; J Cereb Circul. 2004;35:1862–6.

    Article  Google Scholar 

  22. Rabinstein AA, Weigand S, Atkinson JL, Wijdicks EF. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke; J Cereb Circul. 2005;36:992–7.

    Article  Google Scholar 

  23. Findlay JM, Weir BK, Steinke D, Tanabe T, Gordon P, Grace M. Effect of intrathecal thrombolytic therapy on subarachnoid clot and chronic vasospasm in a primate model of SAH. J Neurosurg. 1988;69:723–35.

    Article  CAS  PubMed  Google Scholar 

  24. Tsuji T, Cook DA, Weir BK, Handa Y. Effect of clot removal on cerebrovascular contraction after subarachnoid hemorrhage in the monkey: pharmacological study. Heart Vessel. 1996;11:69–79.

    Article  CAS  Google Scholar 

  25. Findlay JM, Kassell NF, Weir BK, et al. A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery. 1995;37:168–76. discussion 77–8.

    Article  CAS  PubMed  Google Scholar 

  26. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6:1–9.

    Article  CAS  PubMed  Google Scholar 

  27. Friedman JA, Goerss SJ, Meyer FB, et al. Volumetric quantification of Fisher Grade 3 aneurysmal subarachnoid hemorrhage: a novel method to predict symptomatic vasospasm on admission computerized tomography scans. J Neurosurg. 2002;97:401–7.

    Article  PubMed  Google Scholar 

  28. Macdonald RL, Weir BK. A review of hemoglobin and the pathogenesis of cerebral vasospasm. Stroke; J Cereb Circul. 1991;22:971–82.

    Article  CAS  Google Scholar 

  29. Lin CL, Shih HC, Dumont AS, et al. The effect of 17beta-estradiol in attenuating experimental subarachnoid hemorrhage-induced cerebral vasospasm. J Neurosurg. 2006;104:298–304.

    Article  CAS  PubMed  Google Scholar 

  30. Oldfield EH, Loomba JJ, Monteith SJ, et al. Safety and pharmacokinetics of sodium nitrite in patients with subarachnoid hemorrhage: a Phase IIA study. J Neurosurg. 2013;119:634–41.

    Article  CAS  PubMed  Google Scholar 

  31. Mukherjee KK, Singh SK, Khosla VK, Mohindra S, Salunke P. Safety and efficacy of sildenafil citrate in reversal of cerebral vasospasm: A feasibility study. Surgic Neurol Internat. 2012;3:3.

    Article  Google Scholar 

  32. Semenza G. Signal transduction to hypoxia-inducible factor 1. Biochem Pharmacol. 2002;64:993–8.

    Article  CAS  PubMed  Google Scholar 

  33. Hishikawa T, Ono S, Ogawa T, Tokunaga K, Sugiu K, Date I. Effects of deferoxamine-activated hypoxia-inducible factor-1 on the brainstem after subarachnoid hemorrhage in rats. Neurosurgery. 2008;62:232–40. discussion 40–1.

    Article  PubMed  Google Scholar 

  34. Yan J, Chen C, Lei J, et al. 2-methoxyestradiol reduces cerebral vasospasm after 48 hours of experimental subarachnoid hemorrhage in rats. Exp Neurol. 2006;202:348–56.

    Article  CAS  PubMed  Google Scholar 

  35. Yanagisawa M, Kurihara H, Kimura S, et al. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature. 1988;332:411–5.

    Article  CAS  PubMed  Google Scholar 

  36. Yamaji T, Johshita H, Ishibashi M, et al. Endothelin family in human plasma and cerebrospinal fluid. The Journal of Clinical Endocrinology and Metabolism. 1990;71:1611–5.

    Article  CAS  PubMed  Google Scholar 

  37. Rubanyi GM, Polokoff MA. Endothelins: molecular biology, biochemistry, pharmacology, physiology, and pathophysiology. Pharmacol Rev. 1994;46:325–415.

    CAS  PubMed  Google Scholar 

  38. Macdonald RL, Higashida RT, Keller E, et al. Randomized trial of clazosentan in patients with aneurysmal subarachnoid hemorrhage undergoing endovascular coiling. Stroke; J Cereb Circul. 2012;43:1463–9These are results from the promising Phase II trial of clazosentan..

    Article  CAS  Google Scholar 

  39. Sugawara T, Jadhav V, Ayer R, Chen W, Suzuki H, Zhang JH. Thrombin inhibition by argatroban ameliorates early brain injury and improves neurological outcomes after experimental subarachnoid hemorrhage in rats. Stroke; J Cereb Circul. 2009;40:1530–2.

    Article  Google Scholar 

  40. Kai Y, Hirano K, Maeda Y, Nishimura J, Sasaki T, Kanaide H. Prevention of the hypercontractile response to thrombin by proteinase-activated receptor-1 antagonist in subarachnoid hemorrhage. Stroke; J Cereb Circul. 2007;38:3259–65.

    Article  CAS  Google Scholar 

  41. Tsurutani H, Ohkuma H, Suzuki S. Effects of thrombin inhibitor on thrombin-related signal transduction and cerebral vasospasm in the rabbit subarachnoid hemorrhage model. Stroke; J Cereb Circul. 2003;34:1497–500.

    Article  CAS  Google Scholar 

  42. Dumont AS, Dumont RJ, Chow MM, et al. Cerebral vasospasm after subarachnoid hemorrhage: putative role of inflammation. Neurosurgery. 2003;53:123–33. discussion 33–5.

    Article  PubMed  Google Scholar 

  43. Bowman G, Bonneau RH, Chinchilli VM, Tracey KJ, Cockroft KM. A novel inhibitor of inflammatory cytokine production (CNI-1493) reduces rodent post-hemorrhagic vasospasm. Neurocrit Care. 2006;5:222–9.

    Article  CAS  PubMed  Google Scholar 

  44. Grisham MB, Granger DN, Lefer DJ. Modulation of leukocyte-endothelial interactions by reactive metabolites of oxygen and nitrogen: relevance to ischemic heart disease. Free radical Biology & Medicine. 1998;25:404–33.

    Article  CAS  Google Scholar 

  45. Fassbender K, Hodapp B, Rossol S, et al. Endothelin-1 in subarachnoid hemorrhage: An acute-phase reactant produced by cerebrospinal fluid leukocytes. Stroke; J Cereb Circul. 2000;31:2971–5.

    Article  CAS  Google Scholar 

  46. McGirt MJ, Pradilla G, Legnani FG, et al. Systemic administration of simvastatin after the onset of experimental subarachnoid hemorrhage attenuates cerebral vasospasm. Neurosurgery. 2006;58:945–51. discussion −51.

    Article  PubMed  Google Scholar 

  47. Tseng MY, Czosnyka M, Richards H, Pickard JD, Kirkpatrick PJ. Effects of acute treatment with statins on cerebral autoregulation in patients after aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 2006;21:E10.

    Article  PubMed  Google Scholar 

  48. ClinicalTrials.gov. Simvastatin in Aneurysmal Subarachnoid Haemorrhage (STASH) a Multicentre Randomised Controlled Clinical Trial. 2013.

  49. Wilkins RH, Odom GL. Intracranial arterial spasm associated with craniocerebral trauma. J Neurosurg. 1970;32:626–33.

    Article  CAS  PubMed  Google Scholar 

  50. Steiger HJ, Aaslid R, Stooss R, Seiler RW. Transcranial doppler monitoring in head injury: relations between type of injury, flow velocities, vasoreactivity, and outcome. Neurosurgery. 1994;34:79–85. discussion −6.

    Article  CAS  PubMed  Google Scholar 

  51. Alford PW, Dabiri BE, Goss JA, Hemphill MA, Brigham MD, Parker KK. Blast-induced phenotypic switching in cerebral vasospasm. Proc Natl Acad Sci U S A. 2011;108:12705–10.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Fukuda T, Hasue M, Ito H. Does traumatic subarachnoid hemorrhage caused by diffuse brain injury cause delayed ischemic brain damage? Comparison with subarachnoid hemorrhage caused by ruptured intracranial aneurysms. Neurosurgery. 1998;43:1040–9.

    Article  CAS  PubMed  Google Scholar 

  53. Woitzik J, Dreier JP, Hecht N, et al. Delayed cerebral ischemia and spreading depolarization in absence of angiographic vasospasm after subarachnoid hemorrhage. Journal of Cerebral Blood Flow and Metabolism: Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2012;32:203–12Interesting, albeit small study in SAH patients revealing that DCI can occur in the absence of cVSP but may be due to spreading depolorizations..

    Article  Google Scholar 

  54. Dreier JP, Drenckhahn C, Woitzik J, et al. Spreading ischemia after aneurysmal subarachnoid hemorrhage. Acta Neurochirurgica Supplement. 2013;115:125–9.

    PubMed  Google Scholar 

  55. Lauritzen M, Dreier JP, Fabricius M, Hartings JA, Graf R, Strong AJ. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. Journal of Cerebral Blood Flow and Metabolism: Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2011;31:17–35.

    Article  Google Scholar 

  56. Hartings JA, Bullock MR, Okonkwo DO, et al. Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study. Lancet Neurol. 2011;10:1058–64An intriguing, large study in TBI patients that shows that spreading depolorizations are associated with worse clinical outcomes after TBI, without proving causality..

    Article  PubMed  Google Scholar 

  57. Deb S, Gogos AJ, Drummond KJ, Teddy PJ. The role of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia. 2012;19:950–5.

    Article  Google Scholar 

  58. Jakobsen M, Enevoldsen E, Dalager T. Spasm index in subarachnoid haemorrhage: consequences of vasospasm upon cerebral blood flow and oxygen extraction. Acta Neurol Scand. 1990;82:311–20.

    Article  CAS  PubMed  Google Scholar 

  59. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir. 1989;100:12–24.

    Article  CAS  PubMed  Google Scholar 

  60. Washington CW, Zipfel GJ. Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid H. Detection and monitoring of vasospasm and delayed cerebral ischemia: a review and assessment of the literature. Neurocrit Care. 2011;15:312–7.

    Article  PubMed  Google Scholar 

  61. Dankbaar JW, de Rooij NK, Velthuis BK, Frijns CJ, Rinkel GJ, van der Schaaf IC. Diagnosing delayed cerebral ischemia with different CT modalities in patients with subarachnoid hemorrhage with clinical deterioration. Stroke; J Cereb Circul. 2009;40:3493–8.

    Article  Google Scholar 

  62. Sanelli PC, Ugorec I, Johnson CE, et al. Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. AJNR American Journal of Neuroradiology. 2011;32:2047–53.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Rordorf G, Koroshetz WJ, Copen WA, et al. Diffusion- and perfusion-weighted imaging in vasospasm after subarachnoid hemorrhage. Stroke; J Cereb Circul. 1999;30:599–605.

    Article  CAS  Google Scholar 

  64. Vespa PM, Nuwer MR, Juhasz C, et al. Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol. 1997;103:607–15.

    Article  CAS  PubMed  Google Scholar 

  65. Claassen J, Mayer SA, Hirsch LJ. Continuous EEG monitoring in patients with subarachnoid hemorrhage. Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society. 2005;22:92–8.

    Article  Google Scholar 

  66. Khaldi A, Zauner A, Reinert M, Woodward JJ, Bullock MR. Measurement of nitric oxide and brain tissue oxygen tension in patients after severe subarachnoid hemorrhage. Neurosurgery. 2001;49:33–8. discussion 8–40.

    CAS  PubMed  Google Scholar 

  67. Jaeger M, Schuhmann MU, Soehle M, Nagel C, Meixensberger J. Continuous monitoring of cerebrovascular autoregulation after subarachnoid hemorrhage by brain tissue oxygen pressure reactivity and its relation to delayed cerebral infarction. Stroke; J Cereb Circul. 2007;38:981–6.

    Article  Google Scholar 

  68. Barth M, Woitzik J, Weiss C, et al. Correlation of clinical outcome with pressure-, oxygen-, and flow-related indices of cerebrovascular reactivity in patients following aneurysmal SAH. Neurocritical care. 2010;12:234–43.

    Article  PubMed  Google Scholar 

  69. Kistka H, Dewan MC, Mocco J. Evidence-based cerebral vasospasm surveillance. Neurology Research International. 2013;2013:256713.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Unterberg AW, Sakowitz OW, Sarrafzadeh AS, Benndorf G, Lanksch WR. Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2001;94:740–9.

    Article  CAS  PubMed  Google Scholar 

  71. Staub F, Graf R, Gabel P, Kochling M, Klug N, Heiss WD. Multiple interstitial substances measured by microdialysis in patients with subarachnoid hemorrhage. Neurosurgery. 2000;47:1106–15. discussion 15–6.

    Article  CAS  PubMed  Google Scholar 

  72. Vajkoczy P, Horn P, Thome C, Munch E, Schmiedek P. Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;98:1227–34.

    Article  PubMed  Google Scholar 

  73. von Helden A, Schneider GH, Unterberg A, Lanksch WR. Monitoring of jugular venous oxygen saturation in comatose patients with subarachnoid haemorrhage and intracerebral haematomas. Acta Neurochir Suppl. 1993;59:102–6.

    Google Scholar 

  74. Heran NS, Hentschel SJ, Toyota BD. Jugular bulb oximetry for prediction of vasospasm following subarachnoid hemorrhage. The Canadian Journal of Neurological Sciences. 2004;31:80–6.

    PubMed  Google Scholar 

  75. Dorhout Mees SM, Rinkel GJ, Feigin VL, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. The Cochrane database of systematic reviews 2007:CD000277.

  76. Philippon J, Grob R, Dagreou F, Guggiari M, Rivierez M, Viars P. Prevention of vasospasm in subarachnoid haemorrhage. A controlled study with nimodipine. Acta neurochirurgica. 1986;82:110–4.

    Article  CAS  PubMed  Google Scholar 

  77. Tani E, Matsumoto T. Continuous elevation of intracellular Ca2+ is essential for the development of cerebral vasospasm. Curr Vasc Pharmacol. 2004;2:13–21.

    Article  CAS  PubMed  Google Scholar 

  78. Yamaura I, Tani E, Saido TC, Suzuki K, Minami N, Maeda Y. Calpain-calpastatin system of canine basilar artery in vasospasm. J Neurosurg. 1993;79:537–43.

    Article  CAS  PubMed  Google Scholar 

  79. Muehlschlegel S, Sims JR. Dantrolene: mechanisms of neuroprotection and possible clinical applications in the neurointensive care unit. Neurocritical care. 2009;10:103–15.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  80. Frandsen A, Schousboe A. Dantrolene prevents glutamate cytotoxicity and Ca2+ release from intracellular stores in cultured cerebral cortical neurons. J Neurochem. 1991;56:1075–8.

    Article  CAS  PubMed  Google Scholar 

  81. Salomone S, Soydan G, Moskowitz MA, Sims JR. Inhibition of cerebral vasoconstriction by dantrolene and nimodipine. Neurocritical care. 2009;10:93–102.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  82. Muehlschlegel S, Rordorf G, Bodock M, Sims JR. Dantrolene mediates vasorelaxation in cerebral vasoconstriction: a case series. Neurocritical care. 2009;10:116–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  83. Muehlschlegel S, Rordorf G, Sims J. Effects of a single dose of dantrolene in patients with cerebral vasospasm after subarachnoid hemorrhage: a prospective pilot study. Stroke; J Cereb Circul. 2011;42:1301–6.

    Article  CAS  Google Scholar 

  84. Majidi S, Grigoryan M, Tekle WG, Qureshi AI. Intra-arterial dantrolene for refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Neurocritical care. 2012;17:245–9.

    Article  PubMed  Google Scholar 

  85. ClinicalTrials.gov. Safety Study of Dantrolene to Treat Cerebral Vasospasm After Subarachnoid Hemorrhage. 2013. www.ClinicalTrials.gov

  86. Treggiari MM, Deem S. Which H is the most important in triple-H therapy for cerebral vasospasm? Curr Opin Crit Care. 2009;15:83–6.

    Article  PubMed  Google Scholar 

  87. Muench E, Horn P, Bauhuf C, et al. Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med. 2007;35:1844–51. quiz 52.

    Article  PubMed  Google Scholar 

  88. Naidech AM, Jovanovic B, Wartenberg KE, et al. Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage. Crit Care Med. 2007;35:2383–9.

    Article  CAS  PubMed  Google Scholar 

  89. Zwienenberg-Lee M, Hartman J, Rudisill N, et al. Effect of prophylactic transluminal balloon angioplasty on cerebral vasospasm and outcome in patients with Fisher grade III subarachnoid hemorrhage: results of a phase II multicenter, randomized, clinical trial. Stroke; J Cereb Circul. 2008;39:1759–65.

    Article  Google Scholar 

  90. Vergouwen MD, Meijers JC, Geskus RB, et al. Biologic effects of simvastatin in patients with aneurysmal subarachnoid hemorrhage: a double-blind, placebo-controlled randomized trial. Journal of Cerebral Blood Flow and Metabolism: Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 2009;29:1444–53.

    Article  CAS  Google Scholar 

  91. Macdonald RL, Kassell NF, Mayer S, et al. Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke; J Cereb Circul. 2008;39:3015–21.

    Article  CAS  Google Scholar 

  92. Macdonald RL, Higashida RT, Keller E, et al. Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet neurology. 2011;10:618–25This is a Phase III trial reporting the absence of efficacy of clazosentan in SAH..

    Article  CAS  PubMed  Google Scholar 

  93. Macdonald RL, Higashida RT, Keller E, et al. Randomised trial of clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid hemorrhage undergoing surgical clipping (CONSCIOUS-2). Acta Neurochir Suppl. 2013;115:27–31This is the second negative trial of clazosentan in SAH..

    PubMed  Google Scholar 

  94. Wong GK, Poon WS, Chan MT, et al. Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage (IMASH): a randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke; J Cereb Circul. 2010;41:921–6.

    Article  CAS  Google Scholar 

  95. Shimoda M, Oda S, Tsugane R, Sato O. Intracranial complications of hypervolemic therapy in patients with a delayed ischemic deficit attributed to vasospasm. J Neurosurg. 1993;78:423–9.

    Article  CAS  PubMed  Google Scholar 

  96. Lee JH, Martin NA, Alsina G, et al. Hemodynamically significant cerebral vasospasm and outcome after head injury: a prospective study. J Neurosurg. 1997;87:221–33.

    Article  CAS  PubMed  Google Scholar 

  97. Roos YB, de Haan RJ, Beenen LF, Groen RJ, Albrecht KW, Vermeulen M. Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in the Netherlands. J Neurol Neurosurg Psychiatry. 2000;68:337–41.

    Article  CAS  PubMed  Google Scholar 

  98. Shimoda M, Takeuchi M, Tominaga J, Oda S, Kumasaka A, Tsugane R. Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic resonance imaging. Neurosurgery. 2001;49:1341–8. discussion 8–50.

    Article  CAS  PubMed  Google Scholar 

  99. Suarez JI, Qureshi AI, Yahia AB, et al. Symptomatic vasospasm diagnosis after subarachnoid hemorrhage: evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Critical care medicine. 2002;30:1348–55.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Susanne Muehlschlegel has received grant support from the American Heart Association.

Saef Izzy declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

Author information

Authors and Affiliations

  1. Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, 01655, USA

    Saef Izzy MD & Susanne Muehlschlegel MD, MPH

  2. Department of Surgery, University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, 01655, USA

    Susanne Muehlschlegel MD, MPH

  3. Department of Anesthesiology/Critical Care, University of Massachusetts Medical School, 55 Lake Ave North, S-5, Worcester, MA, 01655, USA

    Susanne Muehlschlegel MD, MPH

Authors
  1. Saef Izzy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susanne Muehlschlegel MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susanne Muehlschlegel MD, MPH.

Additional information

This article is part of the Topical Collection on Critical Care Neurology

Rights and permissions

Reprints and permissions

About this article

Cite this article

Izzy, S., Muehlschlegel, S. Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage and Traumatic Brain Injury. Curr Treat Options Neurol 16, 278 (2014). https://doi.org/10.1007/s11940-013-0278-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11940-013-0278-x

Keywords

Search

Navigation