Cerebral Vasospasm After Subarachnoid Hemorrhage Differential Diagnoses

1. Sobey CG, Faraci FM. Subarachnoid haemorrhage: what happens to the cerebral arteries?. Clin Exp Pharmacol Physiol. 1998 Nov. 25 (11):867-76. [QxMD MEDLINE Link].

2. Vergouwen MD, Vermeulen M, van Gijn J, Rinkel GJ, Wijdicks EF, Muizelaar JP, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010 Oct. 41 (10):2391-5. [QxMD MEDLINE Link].

3. Romenskaya T, Longhitano Y, Piccolella F, Berger JM, Artico M, Taurone S, et al. Cerebral Vasospasm: Practical Review of Diagnosis and Management. Rev Recent Clin Trials. 2022 Aug 10. [QxMD MEDLINE Link].

4. Budohoski KP, Czosnyka M, Smielewski P, Kasprowicz M, Helmy A, Bulters D, et al. Impairment of cerebral autoregulation predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective observational study. Stroke. 2012 Dec. 43 (12):3230-7. [QxMD MEDLINE Link].

5. Zimmermann M, Seifert V. Endothelin and subarachnoid hemorrhage: an overview. Neurosurgery. 1998 Oct. 43 (4):863-75; discussion 875-6. [QxMD MEDLINE Link].

6. Cheng YW, Li WJ, Dou XJ, Jia R, Yang H, Liu XG, et al. Role of endothelin‑1 and its receptors in cerebral vasospasm following subarachnoid hemorrhage. Mol Med Rep. 2018 Dec. 18 (6):5229-5236. [QxMD MEDLINE Link].

7. Kreiter KT, Mayer SA, Howard G, Knappertz V, Ilodigwe D, Sloan MA, et al. Sample size estimates for clinical trials of vasospasm in subarachnoid hemorrhage. Stroke. 2009 Jul. 40 (7):2362-7. [QxMD MEDLINE Link].

8. Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke. 1985 Jul-Aug. 16 (4):562-72. [QxMD MEDLINE Link].

9. Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001 Sep. 32 (9):2012-20. [QxMD MEDLINE Link].

10. Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006 Jul. 59 (1):21-7; discussion 21-7. [QxMD MEDLINE Link].

11. Inagawa T, Yahara K, Ohbayashi N. Risk factors associated with cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Neurol Med Chir (Tokyo). 2014 Jun 17. 54 (6):465-73. [QxMD MEDLINE Link].

12. Sarrafzadeh AS, Vajkoczy P, Bijlenga P, Schaller K. Monitoring in Neurointensive Care - The Challenge to Detect Delayed Cerebral Ischemia in High-Grade Aneurysmal SAH. Front Neurol. 2014. 5:134. [QxMD MEDLINE Link].

13. [Guideline] Connolly ES Jr et al, American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012 Jun. 43 (6):1711-37. [QxMD MEDLINE Link].

14. Westermaier T, Pham M, Stetter C, Willner N, Solymosi L, Ernestus RI, et al. Value of transcranial Doppler, perfusion-CT and neurological evaluation to forecast secondary ischemia after aneurysmal SAH. Neurocrit Care. 2014 Jun. 20 (3):406-12. [QxMD MEDLINE Link].

15. Nakae R, Yokota H, Yoshida D, Teramoto A. Transcranial Doppler ultrasonography for diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: mean blood flow velocity ratio of the ipsilateral and contralateral middle cerebral arteries. Neurosurgery. 2011 Oct. 69 (4):876-83; discussion 883. [QxMD MEDLINE Link].

16. Rawal S, Barnett C, John-Baptiste A, Thein HH, Krings T, Rinkel GJ. Effectiveness of diagnostic strategies in suspected delayed cerebral ischemia: a decision analysis. Stroke. 2015 Jan. 46 (1):77-83. [QxMD MEDLINE Link].

17. Vulcu S, Wagner F, Santos AF, Reitmeir R, Söll N, Schöni D, et al. Repetitive Computed Tomography Perfusion for Detection of Cerebral Vasospasm-Related Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2019 Jan. 121:e739-e746. [QxMD MEDLINE Link].

18. Abdulazim A, Küppers C, Hackenberg KAM, Neumaier-Probst E, Alzghloul MM, Krebs J, et al. Multidisciplinary and standardized management of patients with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien). 2022 Aug 25. [QxMD MEDLINE Link].

19. 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. 2009 Nov. 40 (11):3493-8. [QxMD MEDLINE Link].

20. Sanelli PC, Anumula N, Johnson CE, Comunale JP, Tsiouris AJ, Riina H, et al. Evaluating CT perfusion using outcome measures of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2013 Feb. 34 (2):292-8. [QxMD MEDLINE Link].

21. Mir DI, Gupta A, Dunning A, Puchi L, Robinson CL, Epstein HA, et al. CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2014 May. 35 (5):866-71. [QxMD MEDLINE Link].

22. Takano K, Hida K, Iwaasa M, Inoue T, Yoshimitsu K. Three-dimensional spin-echo-based black-blood MRA in the detection of vasospasm following subarachnoid hemorrhage. J Magn Reson Imaging. 2019 Mar. 49 (3):800-807. [QxMD MEDLINE Link].

23. Foreman B, Claassen J. Quantitative EEG for the detection of brain ischemia. Crit Care. 2012 Dec 12. 16 (2):216. [QxMD MEDLINE Link].

24. Claassen J, Hirsch LJ, Frontera JA, Fernandez A, Schmidt M, Kapinos G, et al. Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage. Neurocrit Care. 2006. 4 (2):103-12. [QxMD MEDLINE Link].

25. Herman ST, Abend NS, Bleck TP, Chapman KE, et al, Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015 Apr. 32 (2):87-95. [QxMD MEDLINE Link].

26. Przybycien-Szymanska MM, Ashley WW Jr. Biomarker Discovery in Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 2015 Jul. 24 (7):1453-64. [QxMD MEDLINE Link].

27. Yokose N, Sakatani K, Murata Y, Awano T, Igarashi T, Nakamura S, et al. Bedside monitoring of cerebral blood oxygenation and hemodynamics after aneurysmal subarachnoid hemorrhage by quantitative time-resolved near-infrared spectroscopy. World Neurosurg. 2010 May. 73 (5):508-13. [QxMD MEDLINE Link].

28. Origitano TC, Wascher TM, Reichman OH, Anderson DE. Sustained increased cerebral blood flow with prophylactic hypertensive hypervolemic hemodilution ("triple-H" therapy) after subarachnoid hemorrhage. Neurosurgery. 1990 Nov. 27 (5):729-39; discussion 739-40. [QxMD MEDLINE Link].

29. Egge A, Waterloo K, Sjøholm H, Solberg T, Ingebrigtsen T, Romner B. Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study. Neurosurgery. 2001 Sep. 49 (3):593-605; discussion 605-6. [QxMD MEDLINE Link].

30. Lennihan L, Mayer SA, Fink ME, Beckford A, Paik MC, Zhang H, et al. Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage : a randomized controlled trial. Stroke. 2000 Feb. 31 (2):383-91. [QxMD MEDLINE Link].

31. Reynolds MR, Buckley RT, Indrakanti SS, Turkmani AH, Oh G, Crobeddu E, et al. The safety of vasopressor-induced hypertension in subarachnoid hemorrhage patients with coexisting unruptured, unprotected intracranial aneurysms. J Neurosurg. 2015 Oct. 123 (4):862-71. [QxMD MEDLINE Link].

32. Darby JM, Yonas H, Marks EC, Durham S, Snyder RW, Nemoto EM. Acute cerebral blood flow response to dopamine-induced hypertension after subarachnoid hemorrhage. J Neurosurg. 1994 May. 80 (5):857-64. [QxMD MEDLINE Link].

33. Meyer R, Deem S, Yanez ND, Souter M, Lam A, Treggiari MM. Current practices of triple-H prophylaxis and therapy in patients with subarachnoid hemorrhage. Neurocrit Care. 2011 Feb. 14 (1):24-36. [QxMD MEDLINE Link].

34. Miller JA, Dacey RG Jr, Diringer MN. Safety of hypertensive hypervolemic therapy with phenylephrine in the treatment of delayed ischemic deficits after subarachnoid hemorrhage. Stroke. 1995 Dec. 26 (12):2260-6. [QxMD MEDLINE Link].

35. Komotar RJ, Schmidt JM, Starke RM, Claassen J, Wartenberg KE, Lee K, et al. Resuscitation and critical care of poor-grade subarachnoid hemorrhage. Neurosurgery. 2009 Mar. 64 (3):397-410; discussion 410-1. [QxMD MEDLINE Link].

36. Muehlschlegel S, Dunser MW, Gabrielli A, Wenzel V, Layon AJ. Arginine vasopressin as a supplementary vasopressor in refractory hypertensive, hypervolemic, hemodilutional therapy in subarachnoid hemorrhage. Neurocrit Care. 2007. 6 (1):3-10. [QxMD MEDLINE Link].

37. Dorhout Mees SM, Rinkel GJ, Feigin VL, Algra A, van den Bergh WM, Vermeulen M, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2007 Jul 18. CD000277. [QxMD MEDLINE Link].

38. Allen GS, Ahn HS, Preziosi TJ, Battye R, Boone SC, Boone SC, et al. Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med. 1983 Mar 17. 308 (11):619-24. [QxMD MEDLINE Link].

39. Durrant JC, Hinson HE. Rescue therapy for refractory vasospasm after subarachnoid hemorrhage. Curr Neurol Neurosci Rep. 2015. 15 (2):521. [QxMD MEDLINE Link].

40. Otite F, Mink S, Tan CO, Puri A, Zamani AA, Mehregan A, et al. Impaired cerebral autoregulation is associated with vasospasm and delayed cerebral ischemia in subarachnoid hemorrhage. Stroke. 2014 Mar. 45 (3):677-82. [QxMD MEDLINE Link].

41. Young AM, Karri SK, Helmy A, Budohoski KP, Kirollos RW, Bulters DO, et al. Pharmacologic Management of Subarachnoid Hemorrhage. World Neurosurg. 2015 Jul. 84 (1):28-35. [QxMD MEDLINE Link].

42. Solar P, Mackerle Z, Joukal M, Jancalek R. Non-steroidal anti-inflammatory drugs in the pathophysiology of vasospasms and delayed cerebral ischemia following subarachnoid hemorrhage: a critical review. Neurosurg Rev. 2021 Apr. 44 (2):649-658. [QxMD MEDLINE Link].

43. Jentzsch J, Ziganshyna S, Lindner D, Merkel H, Mucha S, Schob S, et al. Nimodipine vs. Milrinone - Equal or Complementary Use? A Retrospective Analysis. Front Neurol. 2022. 13:939015. [QxMD MEDLINE Link]. [Full Text].

44. Shen J, Shen J, Zhu K, Zhou H, Tian H, Yu G. Efficacy of Statins in Cerebral Vasospasm, Mortality, and Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. World Neurosurg. 2019 Nov. 131:e65-e73. [QxMD MEDLINE Link].

45. Macdonald RL, Kassell NF, Mayer S, Ruefenacht D, Schmiedek P, Weidauer 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. 2008 Nov. 39 (11):3015-21. [QxMD MEDLINE Link].

46. Macdonald RL, Higashida RT, Keller E, Mayer SA, Molyneux A, Raabe A, 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 Neurol. 2011 Jul. 10 (7):618-25. [QxMD MEDLINE Link].

47. Saber H, Desai A, Palla M, Mohamed W, Seraji-Bozorgzad N, Ibrahim M. Efficacy of Cilostazol in Prevention of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis. J Stroke Cerebrovasc Dis. 2018 Nov. 27 (11):2979-2985. [QxMD MEDLINE Link].

48. Chen PR, Bulsara K, Lopez-Rivera V, Sheriff FG, Sanzgiri A, Sheth S, et al. Use of single versus multiple vasodilator agents in the treatment of cerebral vasospasm: is more better than less?. Acta Neurochir (Wien). 2021 Jan. 163 (1):161-168. [QxMD MEDLINE Link].

49. Tsogkas I, Malinova V, Schregel K, Mielke D, Behme D, Rohde V, et al. Angioplasty with the scepter C dual lumen balloon catheter and postprocedural result evaluation in patients with subarachnoid hemorrhage related vasospasms. BMC Neurol. 2020 Jun 29. 20 (1):260. [QxMD MEDLINE Link]. [Full Text].

50. Zwienenberg-Lee M, Hartman J, Rudisill N, Madden LK, Smith K, Eskridge J, 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. 2008 Jun. 39 (6):1759-65. [QxMD MEDLINE Link].

51. Thiery L, Carle X, Testud B, Boulouis G, Habert P, Tradi F, et al. Distal cerebral vasospasm treatment following aneurysmal subarachnoid hemorrhage using the Comaneci device: technical feasibility and single-center preliminary results. J Neurointerv Surg. 2022 May 18. [QxMD MEDLINE Link].

52. Salem MM, Khalife J, Desai S, Sharashidze V, Badger C, Kuhn AL, et al. COManeci MechANical dilation for vasospasm (COMMAND): multicenter experience. J Neurointerv Surg. 2022 Aug 24. [QxMD MEDLINE Link].

53. Treggiari MM, Walder B, Suter PM, Romand JA. Systematic review of the prevention of delayed ischemic neurological deficits with hypertension, hypervolemia, and hemodilution therapy following subarachnoid hemorrhage. J Neurosurg. 2003 May. 98 (5):978-84. [QxMD MEDLINE Link].

54. Rinkel GJ, Feigin VL, Algra A, van Gijn J. Circulatory volume expansion therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2004 Oct 18. CD000483. [QxMD MEDLINE Link].

William W Ashley, Jr, MD, PhD, MBA Director of Cerebrovascular and Endovascular Neurosurgery, Sinai Hospital of Baltimore and LifeBridge Health System

William W Ashley, Jr, MD, PhD, MBA is a member of the following medical societies: American Association of Neurological Surgeons, American Heart Association, American Medical Association, American Physiological Society, American Society for Cell Biology, Congress of Neurological Surgeons, National Medical Association, Sigma Xi, The Scientific Research Honor Society, Society for Neuroscience, Society of NeuroInterventional Surgery

Disclosure: Nothing to disclose.

Joseph Driver, MD Resident Physician, Department of Neurosurgery, Brigham and Women's Hospital

Joseph Driver, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Association for Academic Surgery, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Daniel M Heiferman, MD Resident Physician, Department of Neurological Surgery, Loyola University Medical Center

Daniel M Heiferman, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons, International Parkinson and Movement Disorder Society, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from Abbott Neuromodulation for consulting; Received Consulting Fee from ClearPoint Neuro.

• Print this section
• Print the entire contents of
• Print the entire contents of article