What Is a Cerebral Vasospasm?
Cerebral vasospasm (cerebrovascular spasm) refers to the continuous contraction of the intracranial arteries. If the blood vessel is in a spasm state only during angiography, the patient does not have the corresponding symptoms of neurological deficit, which is called asymptomatic vasospasm; if the patient has symptoms of neurological deficit, it is called symptomatic vasospasm, also known as delayed onset Bloody neurological dysfunction. Cerebral vasospasm is one of the most common complications of aneurysmal subarachnoid hemorrhage.
- English name
- Intracranial Vasospasm
- English alias
- Visiting department
- Neurology
- Common locations
- Cerebrovascular
- Common causes
- Blood and its degradation products flowing into the subarachnoid space after an intracranial aneurysm ruptures
- Common symptoms
- Deteriorated state of consciousness with hemiplegia, anaesthesia, aphasia, headache, vomiting, increased body temperature, and increased white blood cell count
Basic Information
Causes of cerebral vasospasm
- Rupture of intracranial aneurysms often leads to subarachnoid hemorrhage. The blood flowing into the subarachnoid space and its degradation products are the main causes of cerebral vasospasm. Craniocerebral injury, craniocerebral surgery, endovascular interventional treatment, tuberculous and purulent meningitis, migraine, hypertensive encephalopathy can also induce cerebral vasospasm.
Clinical manifestations of cerebral vasospasm
- Cerebral vasospasm itself has no typical specific clinical manifestations. Generally, 3 to 5 days after subarachnoid hemorrhage, if the state of consciousness deteriorates, it may even be accompanied by newly emerged localized signs such as hemiplegia and hemiplegia , Aphasia, and manifestations of increased intracranial pressure, such as headache, vomiting, etc., clinically excluded electrolyte disorders, CT excluding secondary hydrocephalus and intracranial hematoma, the possibility of cerebral vasospasm needs to be highly suspected. There is also the possibility of cerebrovascular spasm due to elevated body temperature and increased white blood cell count.
Cerebral vasospasm examination
- 1. Digital Subtraction Angiography (DSA)
- It is the "gold standard" for the diagnosis of cerebral vasospasm. It has a high positive detection rate for aneurysms and cerebral vascular malformations, and can clearly show the branches of cerebral vasculature at all levels. If cerebral angiography confirms that the patient has severe cerebral vasospasm, treatment should be given as soon as possible.
- 2. Transcranial Doppler Ultrasound (TCD)
- It is a commonly used method for detecting cerebral vasospasm. If the blood flow velocity of local cerebral blood vessels is increased, it indicates that there is vascular stenosis caused by vasospasm. Its main advantage is that it is non-invasive and can be repeatedly and repeatedly tested. It can be used to dynamically detect the course of vasospasm and evaluate the treatment effect. Can determine some specific intracranial vascular segments.
- 3.CT
- The accuracy of diagnosis of acute subarachnoid hemorrhage occurring within 12 hours is high, and the location of intracranial aneurysm can be inferred from this. The risk of cerebral vasospasm can be inferred from the amount of bleeding shown by CT within 24 hours after subarachnoid hemorrhage.
- 4.CT angiography (CTA) and magnetic resonance angiography (MRA)
- High-resolution CTA and CT perfusion imaging can accurately diagnose severe vasospasm of major intracranial vessels, but it has certain limitations for diagnosing vasospasm of small arteries and distinguishing mild and moderate spasms.
Cerebral vasospasm treatment
- Cause treatment
- Identify the cause as soon as possible and deal with the primary disease in time, such as early treatment of intracranial aneurysms, reduction of local vascular stimulation and injury of craniocerebral surgery or intravascular interventional operations, etc.
- 2. Drug treatment
- Nimodipine, Fasudil, etc. can be used to treat cerebral vasospasm. Other treatments such as endovascular treatment and improvement of cerebral perfusion, etc., need to choose a specific treatment plan according to the actual condition of the patient.
Cerebral vasospasm prevention
- The following prevention and treatment of cerebral vasospasm are mainly aimed at cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage. Other types of cerebral vasospasm can be used as a reference and treated as appropriate according to the actual situation of the patient. Including etiology treatment, prevention-oriented, full-course treatment, prevention and treatment of complications.
- 1. Imaging examination indicates cerebral vasospasm, and the patient has clinical symptoms, which requires early treatment and dynamic monitoring.
- 2. Cerebrovascular spasm is suggested, but the patient has no clinical symptoms. Prophylactic treatment and dynamic monitoring are recommended.
- 3. No cerebral vasospasm was found, but patients with clinical symptoms also needed treatment and dynamic monitoring.
- 4. For patients with high risk factors for cerebral vasospasm, such as spontaneous aneurysmal subarachnoid hemorrhage, craniocerebral injury subarachnoid hemorrhage, and after large blood vessel surgery, etc., although the patient has no clinical symptoms, it is still necessary Strengthen disease monitoring and preventive treatment.
- In short, early diagnosis and early effective prevention and treatment measures are the key links to reduce the occurrence of cerebral vasospasm and improve the prognosis.