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Cerebral Vasospasm Following Subarachnoid Hemorrhage.
MedLine Citation:
PMID:  12194810     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Cerebral vasospasm and related ischemic stroke continue to be significant complicating factors in the course of many patients with subarachnoid hemorrhage from berry aneurysm rupture. The risk of this well-recognized but poorly understood complication can be estimated on the basis of patient medical history, neurologic examination, and head CT findings. Every patient with possible risk needs specialized neurologic intensive care unit care after aneurysm obliteration. Surgical and pharmacologic wash-out of subarachnoid blood around the basal arteries, proper management of intracranial pressure and fluid status, hyponatremia, hypomagnesemia, and fever, as well as use of calcium channel blockers, have been considered helpful in patient management prior to and with the symptomatic vasospasm development. Transcranial Doppler (TCD) ultrasound is important in detecting vasospasm before the patient suffers ischemic neurologic deficit or infarct. Elevated TCD velocities often initiate the use of triple-H (HHH: hypertension, hemodilution, and hypervolemia) therapy and subsequently guide it. Up to the end of the first 3 weeks after subarachnoid hemorrhage and aneurysm obliteration, development of any focal neurologic deficit or mental deterioration, unless convincingly proven otherwise, is assumed to be from cerebral vasospasm. When a hemodynamically significant vasospasm in the arterial segments of clinical concern is suggested, emergency cerebral angiography with balloon dilatation angioplasty or intra-arterial infusion of vasodilating agents may be helpful in relieving ischemic symptoms.
Authors:
M. Akif Topcuoglu; Johnny C. Pryor; Christopher S. Ogilvy; J. Philip Kistler
Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  4     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-Aug-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  373-384     Citation Subset:  -    
Affiliation:
Neurovascular Surgery,() Massachusetts General Hospital, 55 Fruit Street, VBK 802, Boston, MA 02114, USA. pkistler@partners.org
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