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Minerva Anestesiologica 2020 May 21

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, Université Libre de Bruxelles - Hôpital Erasme, Bruxelles, Belgium; 2 Division of Clinical Neurophysiology and Comprehensive Epilepsy Center, Yale School of Medicine, New Haven, CT, USA


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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; Delayed cerebral ischemia; Vasospasm; Continuous EEG monitoring; Transcranial doppler

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