A Review of Delayed Ischemic Neurologic Deficit Following Aneurysmal Subarachnoid Hemorrhage: Historical Overview, Current Treatment, and Pathophysiology

Al‐Tamimi, Yahia; Orsi, Nicolas M.; Quinn, Audrey; Homer‐Vanniasinkam, Shervanthi; Ross, Stuart A.

doi:10.1016/j.wneu.2010.02.005

Cited by 99 publications

(65 citation statements)

References 141 publications

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“…Although multiple factors contribute to poor outcome, a major focus is preventing delayed cerebral ischemia. For example, approximately one-third of patients with subarachnoid hemorrhage will develop secondary brain injury within two weeks of the initial event primarily due to cerebral vasospasm [4]. Consequently, a major focus of neurointensive care is maintaining adequate cerebral blood flow (CBF) through treatments such as administering nimodipine, inducing hypertension, and intervening with surgical or pharmacological angioplasty [5].…”

Section: Introductionmentioning

confidence: 99%

Assessment of a multi-layered diffuse correlation spectroscopy method for monitoring cerebral blood flow in adults

Verdecchia

Diop

Lee

et al. 2016

Biomed. Opt. Express

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Diffuse correlation spectroscopy (DCS) is a promising technique for brain monitoring as it can provide a continuous signal that is directly related to cerebral blood flow (CBF); however, signal contamination from extracerebral tissue can cause flow underestimations. The goal of this study was to investigate whether a multi-layered (ML) model that accounts for light propagation through the different tissue layers could successfully separate scalp and brain flow when applied to DCS data acquired at multiple source-detector distances. The method was first validated with phantom experiments. Next, experiments were conducted in a pig model of the adult head with a mean extracerebral tissue thickness of 9.8 ± 0.4 mm. Reductions in CBF were measured by ML DCS and computed tomography perfusion for validation; excellent agreement was observed by a mean difference of 1.2 ± 4.6% (CI 95% : −31.1 and 28.6) between the two modalities, which was not significantly different.

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Section: Introductionmentioning

confidence: 99%

Assessment of a multi-layered diffuse correlation spectroscopy method for monitoring cerebral blood flow in adults

Verdecchia

Diop

Lee

et al. 2016

Biomed. Opt. Express

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“…Anevrizmatik SAK hastalarında, erken (0-3 gün) cerrahi müdahale sonuçlarının orta (4-7 gün) ve geç cerrahi müdahale sonuçlarına göre daha iyi olduğu belirtilmektedir. SAK sonrası 72 saat içinde gelişen iskemiden küçük çaplı arteriyollerin spazmı sorumlu tutulmaktadır (6) . Hastaların tedavilerinin sonucunun değerlendirilme-si açısından Glasgow sonuç skalası (GSS) kullanıl-mıştır.…”

Section: Introductionunclassified

The results of Selective Intraarterial Papaverine Treatment Effect on Subarachnoidal Hemorrhage related Vasospasm

Çöven¹,

Kircelli²,

Peker³

et al. 2018

Okmeydani Medical Journal

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“…Delayed cerebral ischemia (DCI), defined as a delayed neurological decline presumed secondary to cerebral ischemia, occurs in 20-40% of patients with aneurysmal subarachnoid hemorrhage (aSAH) [1]. DCI when left untreated may lead to cerebral infarction and increases morbidity and mortality [2].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Initial Vasopressors Used for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

Roy¹,

McCullough²,

Dhar³

et al. 2017

Cerebrovasc Dis

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Background: The main reason for morbidity after aneurysmal subarachnoid hemorrhage (aSAH) is delayed cerebral ischemia (DCI). The mainstay of medical therapy for treating DCI is induced hypertension with vasopressors to restore cerebral perfusion. Both phenylephrine (PE) and norepinephrine (NE) are commonly used for induced hypertension, but the impact of the initial choice of vasopressor on the efficacy, adverse effects, or outcome after hemodynamic therapy for DCI is unknown. Methods: Sixty-three patients with aSAH between January 2012 and October 2014, who developed DCI (defined as new focal deficit or decline in Glasgow Coma Score) and in which PE (n = 45) or NE (n = 18) treatment was initiated were evaluated in this retrospective study. Baseline characteristics, adverse effects, the need to change or add vasopressors, the response to therapy, the need for endovascular therapy, new infarct development, discharge disposition, and 3 months modified Rankin score were all compared between pressor groups. Results: Baseline characteristics (e.g., Hunt Hess and Fisher grades) were similar. There were no differences in the overall rate of complications including arrhythmia, pulmonary edema, or kidney injury. However, those initiated on PE were more likely to be changed to an alternate vasopressor (64 vs. 33%, p = 0.016), mostly for bradycardia or failure to reach therapeutic targets. Patients initially treated with PE were less likely to respond neurologically (71 vs. 94%, p = 0.01) or to be discharged to home or acute rehabilitation facilities (73 vs. 94%, p = 0.02) and were more likely to have a delayed infarct on imaging (62 vs. 33%, p = 0.04). Conclusions: Our study suggests that patients with DCI after aSAH initiated on PE are more likely to require treatment change to another vasopressor and are at greater risk for poor clinical outcomes compared to patients started on NE. Larger comparative studies are warranted.

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A Review of Delayed Ischemic Neurologic Deficit Following Aneurysmal Subarachnoid Hemorrhage: Historical Overview, Current Treatment, and Pathophysiology

Cited by 99 publications

References 141 publications

Assessment of a multi-layered diffuse correlation spectroscopy method for monitoring cerebral blood flow in adults

Assessment of a multi-layered diffuse correlation spectroscopy method for monitoring cerebral blood flow in adults

The results of Selective Intraarterial Papaverine Treatment Effect on Subarachnoidal Hemorrhage related Vasospasm

Comparison of Initial Vasopressors Used for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

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