Cerebral Vasospasm After Subarachnoid Hemorrhage Guidelines

Updated: Jul 10, 2016
  • Author: William W Ashley, Jr, MD, PhD, MBA; Chief Editor: Brian H Kopell, MD  more...
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Guidelines

Guidelines Summary

In 2012, the American Heart Association and the American Stroke Association published updated evidence-based guidelines on the comprehensive management of aneurysmal subarachnoid hemorrhage (aSAH), including the management of cerebral vasospasm and delayed cerebral ischemia (DCI). [11] These guidelines have been endorsed by the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and the Society of NeuroInterventional Surgery.

Current recommendations for management of cerebral vasospasm and DCI sfter aSAH are as follows [11] :

  • Oral nimodipine should be administered to all patients with aSAH (class I; level of evidence, A) - It should be noted that this agent has been shown to improve neurologic outcomes but not cerebral vasospasm; the value of other calcium antagonists, whether administered orally or intravenously, remains uncertain
  • Maintenance of euvolemia and normal circulating blood volume is recommended to prevent DCI (class I; level of evidence, B) - Revised recommendation from previous guidelines
  • Prophylactic hypervolemia or balloon angioplasty before the development of angiographic spasm is not recommended(class III; level of evidence, B) - New recommendation
  • Transcranial Doppler is reasonable to monitor for the development of arterial vasospasm (class IIa; level of evidence, B) - New recommendation
  • Perfusion imaging with computed tomography (CT) or magnetic resonance imaging (MRI) can be useful to identify regions of potential brain ischemia (class IIa; level of evidence, B) - New recommendation
  • Induction of hypertension is recommended for patients with DCI unless blood pressure is elevated at baseline or cardiac status precludes it (class I; level of evidence, B) - Revised recommendation from previous guidelines
  • Cerebral angioplasty and/or selective intra-arterial vasodilator therapy is reasonable in patients with symptomatic cerebral vasospasm, particularly those who are not rapidly responding to hypertensive therapy (class IIa; level of evidence, B) -  Revised recommendation from previous guidelines