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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 641-647
DOI: 10.4103/ajns.AJNS_15_19
Review Article

Delayed ischemic neurologic deficit after aneurysmal subarachnoid hemorrhage

Vitor Yamaki
Department of Neurosurgery, Universidade De Sao Paulo, São Paulo, SP
,
Daniel Cavalcanti
1   Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ
,
Eberval Figueiredo
Department of Neurosurgery, Universidade De Sao Paulo, São Paulo, SP
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Delayed ischemic neurologic deficit (DIND) is the main preventable cause of poor outcomes in aneurysmal subarachnoid hemorrhage (SAH) patients. Of 50% of survivors from a SAH, approximately 30% of patients will present clinical vasospasm (VS). The cornerstone of the DIND management comprises prevention and early identification. Several diagnostic methods have been proposed differing in efficacy, invasiveness, and costs. Serial neurological examination is the most reliable method to detect a new neurological deficit. On the other hand, comatose patients require advanced monitoring methods which identify changes in the microcirculatory environment, brain autoregulation, and spreading depolarization. Multimodality monitoring with continuous electroencephalography, microdialysis, and intracranial pressure monitoring represents altogether the current state-of-art technology for the intensive care of SAH patients. Moreover, advances in genetic biomarkers to predict clinical VS have shown consistent accuracy which may in the near future allow the early prediction of DIND through a simple blood test. Several clinical trials have tested drugs with theoretical effects on DIND prevention or treatment. Nevertheless, nimodipine remains the Holy Grail in the prevention of clinical VS. Among rescue therapies, the endovascular treatment through intra-arterial vasodilator (verapamil or nicardipine) infusion is the most employed method for DIND reversal; however, there is no good quality evidence comparing results of intra-arterial infusion of vasodilators versus balloon angioplasty. Although we have addressed the most refined technology in the management of SAH and DIND, the clinical experience and strict follow-up in neurointensive care will be determinant for favorable long-term outcomes.

Key-words:

Critical care - delayed ischemic deficit - intracranial aneurysms - neurocritical care - subarachnoid hemorrhage - vasospasm

Financial support and sponsorship

Nil.




Publikationsverlauf

Artikel online veröffentlicht:
09. September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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