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Delayed Cerebral Ischemia after Subarachnoid Hemorrhage
Journal article   Peer reviewed

Delayed Cerebral Ischemia after Subarachnoid Hemorrhage

Asad Ikram, Muhammad Ali Javaid, Santiago Ortega-Gutierrez, Magdy Selim, Sarah Kelangi, Syed Muhammad Hamza Anwar, Michel T. Torbey and Afshin A. Divani
Journal of stroke and cerebrovascular diseases, Vol.30(11), pp.106064-106064
11/2021
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106064
PMID: 34464924

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Abstract

Delayed cerebral ischemia (DCI) is the most feared complication of aneurysmal subarachnoid hemorrhage (aSAH). It increases the mortality and morbidity associated with aSAH. Previously, large cerebral artery vasospasm was thought to be the sole major contributing factor associated with increased risk of DCI. Recent literature has challenged this concept. We conducted a literature search using PUBMED as the prime source of articles discussing various other factors which may contribute to the development of DCI both in the presence or absence of large cerebral artery vasospasm. These factors include microvascular spasm, micro-thrombosis, cerebrovascular dysregulation, and cortical spreading depolarization. These factors collectively result in inflammation of brain parenchyma, which is thought to precipitate early brain injury and DCI. We conclude that diagnostic modalities need to be refined in order to diagnose DCI more efficiently in its early phase, and newer interventions need to be developed to prevent and treat this condition. These newer interventions are currently being studied in experimental models. However, their effectiveness on patients with aSAH is yet to be determined.
 Aneurysmal subarachnoid hemorrhage Cortical spreading depolarization Delayed cerebral ischemia Vasospasm

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