Cerebral Vasospasm

Abstract

Summary Given the large societal burden from morbidity and mortality associated with traumatic brain injury (TBI), this disease entity has been the focus of extensive research over the past decades. Since primary injury in TBI is preventable whereas secondary injury is treatable, most of the research effort has been targeted at identifying factors that contribute to secondary injury and ways to minimize their deleterious effects. Whether post-traumatic vasospasm is one such factor is open for debate. Although radiological or anatomical vasospasm following head injury has been repeatedly demonstrated using various diagnostic techniques, its clinical significance is still under investigation. At the present time, no proven treatment regimen aimed specifically at decreasing the potential detrimental effects of post-traumatic vasospasm exists. Although calcium channel blockers have shown some promise in decreasing death or severe disability in those with traumatic subarachnoid haemorrhage, whether their mechanism is by minimizing vasospasm is open to speculation. Therefore, currently, vigilant diagnostic surveillance, including serial head CT’s and the prevention of secondary brain damage due to hypotension, hypoxia, and intracranial hypertension, may be more cost effective than attempting to minimize post-traumatic vasospasm.

Thrombectomy for ischemic stroke: meta-analyses of recurrent strokes, vasospasms, and subarachnoid hemorrhages

“…Vasospasms are, Electronic supplementary material The online version of this article (doi:10.1007/s00415-016-8205-1) contains supplementary material, which is available to authorized users. especially, common after subarachnoid hemorrhage, or traumatic brain injury [10][11][12], and typically occur between 2 and 14 days after the primary event [12]. Finally, vasospasm can be a cause of (recurrent) ischemic stroke [13,14].…”

Imaging of Intracranial Hemorrhage

“…Traumatic SAH typically distributes in the cerebral sulci overlying the brain near the vertex of the head and tends to spare the basal cisterns ( Figure 1 ), although severe trauma may result in diffuse SAH. In the setting of a large volume of traumatic SAH, cerebral arterial vasospasm may rarely develop, which places patients at risk of cerebral infarction several days following the traumatic event [ 8 , 9 ].…”

Intracranial Hemorrhage: Mechanisms of Secondary Brain Injury

“…These responses have been studied most extensively in the context of vasospasm after aSAH. It has been pointed out that vasospasm also plays a role after the different types of hemorrhage after TBI [64, 65], but it is unclear whether the treatment of post-traumatic vasospasm improves outcome.…”