Detection and Monitoring of Vasospasm and Delayed Cerebral Ischemia: A Review and Assessment of the Literature

Washington, Chad W.; Zipfel, Gregory J.

doi:10.1007/s12028-011-9594-8

Cited by 130 publications

(87 citation statements)

References 32 publications

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“…35 Zhang et al showed that quantitative data from CTP imaging can be used to prospectively determine if the vasospasm is severe enough to cause symptomatic changes in the patient. 40 Early CTP imaging can also efficaciously stratify patients at risk for developing DCI.…”

Section: Cta and Ct Perfusionmentioning

confidence: 99%

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Al‐Mufti

Amuluru²,

Changa³

et al. 2017

Neurosurgical Focus

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OBJECTIVELittle is known regarding the natural history of posttraumatic vasospasm. The authors review the pathophysiology of posttraumatic vasospasm (PTV), its associated risk factors, the efficacy of the technologies used to detect PTV, and the management/treatment options available today.METHODSThe authors performed a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following databases: PubMed, Google Scholar, and CENTRAL (the Cochrane Central Register of Controlled Trials). Outcome variables extracted from each study included epidemiology, pathophysiology, time course, predictors of PTV and delayed cerebral ischemia (DCI), optimal means of surveillance and evaluation of PTV, application of multimodality monitoring, modern management and treatment options, and patient outcomes after PTV. Study types were limited to retrospective chart reviews, database reviews, and prospective studies.RESULTSA total of 40 articles were included in the systematic review. In many cases of mild or moderate traumatic brain injury (TBI), imaging or ultrasonographic studies are not performed. The lack of widespread assessment makes finding the true overall incidence of PTV a difficult endeavor. The clinical consequences of PTV are important, given the morbidity that can result from it. DCI manifests as new-onset neurological deterioration that occurs beyond the timeframe of initial brain injury. While there are many techniques that attempt to diagnose cerebral vasospasm, digital subtraction angiography is the gold standard. Some predictors of PTV include SAH, intraventricular hemorrhage, low admission Glasgow Coma Scale (GCS) score (< 9), and young age (< 30 years).CONCLUSIONSGiven these results, clinicians should suspect PTV in young patients presenting with intracranial hemorrhage (ICH), especially SAH and/or intraventricular hemorrhage, who present with a GCS score less than 9. Monitoring and regulation of CNS metabolism following TBI/ICH-induced vasospasm may play an important adjunct role to the primary prevention of vasospasm.

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Section: Cta and Ct Perfusionmentioning

confidence: 99%

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Al‐Mufti

Amuluru²,

Changa³

et al. 2017

Neurosurgical Focus

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“…Much of the outcome is determined by secondary complications many of which are treatable if diagnosed in a timely fashion. Between 20-40% of SAH patients either clinically deteriorate or have evidence of new ischemia on repeat brain imaging from vasospasm, together termed delayed cerebral ischemia [5,42,43]. Delayed cerebral ischemia is associa ted with worse outcome [5], but may be particularly challenging to diagnose in the comatose patient [6].…”

Section: Clinical Scenario: Delayed Cerebral Ischemia After Subarachnmentioning

confidence: 99%

“…Currently, the only serial detection method in routine use is transcranial Doppler ultrasonography (TCD). Although mean blood fl ow velocities of > 120 cm/s are around 60-70% sensitive to changes in the proximal middle cerebral artery (MCA), this cut-off is less reliable (and less well studied) for other territories and does not include the distal vasculature [42]. When used daily, TCDs have been 60-70% sensitive for delayed cerebral ischemia with limited predictive value; they also exhibit frequent false negatives or false positives [44].…”

Section: Clinical Scenario: Delayed Cerebral Ischemia After Subarachnmentioning

confidence: 99%

Quantitative EEG for the Detection of Brain Ischemia

Foreman¹,

Claassen²

2012

Annual Update in Intensive Care and Emergency Medicine 2012

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“…However, the values of the pulsatility index and resistance index were not significantly different between the two groups. Correct interpretation of the pulsatility index is complex, because it depends not only on cerebrovascular resistance but also on several systemic and cerebral variables (11,12). The Rotterdam Study reported that increased mild-to-moderate cerebral blood flow velocity was due to diffuse atherosclerosis or vasoconstriction.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cerebral Blood Flow in Patients with Familial Mediterranean Fever

Çetin

Utku

Atilla

et al. 2017

Arch Neuropsychiatr

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INTRODUCTIONFamilial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by repeated attacks of fever, abdominal pain, pleuritic chest pain, and arthritis. The occurrence of nervous system manifestations in FMF is rare and their association with FMF is still uncertain (1,2). Additional neurologic disorders have been reported in FMF, such as posterior reversible encephalopathy syndrome (PRES), demyelinating lesions, and ischemic stroke (3,4,5). Attacks of FMF with clinical inflammation are only the tip of the iceberg (6). Increases in clinical and subclinical inflammation in FMF might lead to susceptibility to vascular comorbidities such as atherosclerosis, heart disease, and life-threatening secondary systemic amyloidosis due to endothelial dysfunction in FMF patients (7,8). The aim of this study was to assess cerebral blood flow velocities using transcranial Doppler (TCD) ultrasonography in patients with FMF. METHODSA total of 30 consecutively admitted patients aged from 20 to 50 years with a diagnosis of FMF who fulfilled the Livneh criteria for FMF were enrolled in the FMF group. The non-FMF group consisted of 30 age-and sex-matched randomly selected patients who did not have any risk factors for atherosclerosis, such as diabetes, hypertension, and coronary artery disease. All patients with FMF were using colchicine and were not in an attack period. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured. Consent was obtained from the local ethics committee, and all participants gave formal consent.TCD ultrasonography examination was performed with a Multidop X DWL TCD device after the patient had rested for 10 minutes in the supine position. The right and left middle cerebral arteries (MCAs) were insonated from the temporal windows at a depth of 50-65 mm with 2 MHz pulsed Doppler probes. Bilateral peak-systolic, end-diastolic, and mean blood flow velocities in the MCA, pulsatility index values, and resistance index values were recorded. The results for the FMF group were compared with the results for the non-FMF group. Statistical AnalysisThe data were analyzed using the Statistical Package for the Social Sciences 15.0 program (SPSS Inc.; Chicago, IL, USA). A paired t-test and cross-tabs tests were used for statistical analysis, and a value of p<0.05 was considered to be significant.

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Detection and Monitoring of Vasospasm and Delayed Cerebral Ischemia: A Review and Assessment of the Literature

Cited by 130 publications

References 32 publications

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Quantitative EEG for the Detection of Brain Ischemia

Changes in Cerebral Blood Flow in Patients with Familial Mediterranean Fever

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