Recent advances in the management of vasospasm in patients with subarachnoid hemorrhage

BACKGROUND- Cerebral vasospasm in patients with subarachnoid hemorrhage is a major cause of morbidity and mortality. A significant number of patients will develop ischemic complications despite treatment with a calcium channel antagonist and hypervolemic, hypertensive treatment. However, recent advances in prevention and management of vasospasm may improve outcome in patients with subarachnoid hemorrhage. REVIEW SUMMARY- Erythrocyte breakdown products predispose to vasospasm possibly due to activation of the lipooxygenase pathway. Therefore, prevention might include early and effective removal of subarachnoid blood clot by intracisternal administration of thrombolytics. Treatment of symptomatic vasospasm resistant to conventional treatment may require pharmacological or mechanical dilation of involved arteries. Angioplasty is effective in reversing vessel constriction. In addition, intra-arterial infusion of papaverine, a direct-acting smooth muscle relaxant, can reverse vasospasm in arteries inaccessible to angioplasty. CONCLUSIONS- Novel approaches for the prevention and treatment of vasospasm may reduce morbidity and mortality in patients with subarachnoid hemorrhage.