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Vasospasm
Surjith Vattoth, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Subarachnoid hemorrhage (SAH) vasospasm
              • Definitions

                • Exposure to blood breakdown products → reversible stenosis of intracranial arteries
                  • Mild vasospasm: < 25% reduction in vessel patency
                  • Severe vasospasm: > 50% reduction in vessel patency

              IMAGING

              • General Features

                • Imaging Recommendations

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Angiographic Findings

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Schob S et al: Delayed stroke after aneurysm treatment with flow diverters in small cerebral vessels: a potentially critical complication caused by subacute vasospasm. J Clin Med. 8(10), 2019
                                              2. Vulcu S et al: Repetitive computed tomography perfusion for detection of cerebral vasospasm-related hypoperfusion in aneurysmal subarachnoid hemorrhage. World Neurosurg. 121:e739-46, 2019
                                              3. Afat S et al: Diagnostic performance of different perfusion algorithms for the detection of angiographical spasm. J Neuroradiol. 45(5):290-4, 2018
                                              4. Mossa-Basha M et al: Vessel wall MRI characteristics of endovascularly treated aneurysms: association with angiographic vasospasm. J Neurosurg. 1-9, 2018
                                              5. Mandell DM et al: Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 38(2):218-29, 2017
                                              6. Othman AE et al: Volume perfusion CT imaging of cerebral vasospasm: diagnostic performance of different perfusion maps. Neuroradiology. 58(8):787-92, 2016
                                              7. Bacigaluppi S et al: Diagnosis of cerebral vasospasm and risk of delayed cerebral ischemia related to aneurysmal subarachnoid haemorrhage: an overview of available tools. Neurosurg Rev. 38(4):603-18, 2015
                                              8. Fontana J et al: Dynamic autoregulatory response after aneurysmal subarachnoid hemorrhage and its relation to angiographic vasospasm and clinical outcome. Neurocrit Care. 23(3):355-63, 2015
                                              9. Hollingworth M et al: Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia. World Neurosurg. 83(6):1120-6, 2015
                                              10. Jones J et al: Cerebral vasospasm patterns following aneurysmal subarachnoid hemorrhage: an angiographic study comparing coils with clips. J Neurointerv Surg. 7(11):803-7, 2015
                                              11. Walcott BP et al: Diffuse patterns of nonaneurysmal subarachnoid hemorrhage originating from the Basal cisterns have predictable vasospasm rates similar to aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 24(4):795-801, 2015
                                              12. Eddleman CS et al: Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm. Neurosurg Focus. 26(3):E6, 2009
                                              13. Hänggi D et al: Feasibility and safety of intrathecal nimodipine on posthaemorrhagic cerebral vasospasm refractory to medical and endovascular therapy. Clin Neurol Neurosurg. 110(8):784-90, 2008
                                              14. Ionita CC et al: The value of CT angiography and transcranial doppler sonography in triaging suspected cerebral vasospasm in SAH prior to endovascular therapy. Neurocrit Care. 9(1):8-12, 2008
                                              15. Keuskamp J et al: High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 108(3):458-63, 2008
                                              16. Majoie CB et al: Perfusion CT to evaluate the effect of transluminal angioplasty on cerebral perfusion in the treatment of vasospasm after subarachnoid hemorrhage. Neurocrit Care. 6(1):40-4, 2007
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Subarachnoid hemorrhage (SAH) vasospasm
                                                          • Definitions

                                                            • Exposure to blood breakdown products → reversible stenosis of intracranial arteries
                                                              • Mild vasospasm: < 25% reduction in vessel patency
                                                              • Severe vasospasm: > 50% reduction in vessel patency

                                                          IMAGING

                                                          • General Features

                                                            • Imaging Recommendations

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Angiographic Findings

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Staging, Grading, & Classification

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Schob S et al: Delayed stroke after aneurysm treatment with flow diverters in small cerebral vessels: a potentially critical complication caused by subacute vasospasm. J Clin Med. 8(10), 2019
                                                                                          2. Vulcu S et al: Repetitive computed tomography perfusion for detection of cerebral vasospasm-related hypoperfusion in aneurysmal subarachnoid hemorrhage. World Neurosurg. 121:e739-46, 2019
                                                                                          3. Afat S et al: Diagnostic performance of different perfusion algorithms for the detection of angiographical spasm. J Neuroradiol. 45(5):290-4, 2018
                                                                                          4. Mossa-Basha M et al: Vessel wall MRI characteristics of endovascularly treated aneurysms: association with angiographic vasospasm. J Neurosurg. 1-9, 2018
                                                                                          5. Mandell DM et al: Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 38(2):218-29, 2017
                                                                                          6. Othman AE et al: Volume perfusion CT imaging of cerebral vasospasm: diagnostic performance of different perfusion maps. Neuroradiology. 58(8):787-92, 2016
                                                                                          7. Bacigaluppi S et al: Diagnosis of cerebral vasospasm and risk of delayed cerebral ischemia related to aneurysmal subarachnoid haemorrhage: an overview of available tools. Neurosurg Rev. 38(4):603-18, 2015
                                                                                          8. Fontana J et al: Dynamic autoregulatory response after aneurysmal subarachnoid hemorrhage and its relation to angiographic vasospasm and clinical outcome. Neurocrit Care. 23(3):355-63, 2015
                                                                                          9. Hollingworth M et al: Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia. World Neurosurg. 83(6):1120-6, 2015
                                                                                          10. Jones J et al: Cerebral vasospasm patterns following aneurysmal subarachnoid hemorrhage: an angiographic study comparing coils with clips. J Neurointerv Surg. 7(11):803-7, 2015
                                                                                          11. Walcott BP et al: Diffuse patterns of nonaneurysmal subarachnoid hemorrhage originating from the Basal cisterns have predictable vasospasm rates similar to aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 24(4):795-801, 2015
                                                                                          12. Eddleman CS et al: Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm. Neurosurg Focus. 26(3):E6, 2009
                                                                                          13. Hänggi D et al: Feasibility and safety of intrathecal nimodipine on posthaemorrhagic cerebral vasospasm refractory to medical and endovascular therapy. Clin Neurol Neurosurg. 110(8):784-90, 2008
                                                                                          14. Ionita CC et al: The value of CT angiography and transcranial doppler sonography in triaging suspected cerebral vasospasm in SAH prior to endovascular therapy. Neurocrit Care. 9(1):8-12, 2008
                                                                                          15. Keuskamp J et al: High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 108(3):458-63, 2008
                                                                                          16. Majoie CB et al: Perfusion CT to evaluate the effect of transluminal angioplasty on cerebral perfusion in the treatment of vasospasm after subarachnoid hemorrhage. Neurocrit Care. 6(1):40-4, 2007