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Minerva Anestesiologica 2020 December;86(12):1331-9
DOI: 10.23736/S0375-9393.20.14507-3
Copyright © 2020 EDIZIONI MINERVA MEDICA
language: English
How do I manage cerebral vasospasm and delayed cerebral ischemia?
Nicolas GASPARD 1, 2 ✉
1 Department of Neurology, Erasme Hospital, University of Brussels, Brussels, Belgium; 2 Division of Clinical Neurophysiology and Comprehensive Epilepsy Center, Yale School of Medicine, New Haven, CT, USA
Delayed cerebral ischemia (DCI) is the leading cause of mortality and disability in patients who survived the initial bleed of subarachnoid hemorrhage. Currently available guidelines are based on expert opinions derived from small observational studies due to the lack of randomized controlled trials. In this review, we will review some of the available literature and describe our local protocols for prophylaxis, risk stratification, monitoring in patients at risk, including multimodal invasive monitoring, and interventions measures in patients with DCI. These protocols are largely in line with the current guidelines but are deemed to evolve as ongoing and future trials provide stronger evidence to support interventions.
KEY WORDS: Subarachnoid hemorrhage; Vasospasm, intracranial; Ultrasonography, Doppler, transcranial