Journal
NEUROSURGERY CLINICS OF NORTH AMERICA
Volume 21, Issue 2, Pages 353-+Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.nec.2009.10.006
Keywords
Vasospasm; Aneurysmal subarachnoid hemorrhage; Triple-H therapy; Cerebral blood flow
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Vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. This article reviews the risk factors for vasospasm; the various methods for diagnosing vasospasm including the conventional 4-vessel angiography, computed tomographic angiography, and computed tomographic perfusion; the methods to detect vasospasm before clinical onset (including transcranial Doppler ultrasonography); and the recent emergence of multimodality monitoring. A discussion of medical treatment options in the setting of vasospasm is also included; the prophylactic use of neuroprotectants such as nimodipine, statins, and magnesium and the role of hemodynamic augmentation in vasospasm amelioration, including the use of inotropic support in addition to traditional triple-H therapy, are discussed.
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