Review article| Volume 1, ISSUE 1, P19-26, January 1994

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A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage Part I: Incidence and effects

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      Delayed ischaemia due to cerebral ‘vasospasm’ is a significant cause of morbidity and mortality after aneurysm haemorrhage. In a literature review more than 30 000 cases were found where vasospasm after subarachnoid haemorrhage (SAH) was discussed. The incidence of angiographic vasospasm was 43.3% overall, and 67.3% where angiography was done at a time of maximum expected spasm. Symptomatic vasospasm or delayed ischaemic deficit (DID) occurred in 32.5%. There was no difference in incidence and time course between preoperative and postoperative cases. 30% of those with DID died, and permanent neurological deficits occurred in 34%. A fatal outcome was much more likely in the presence of vasospasm, and a satisfactory outcome one third less likely. Vasospasm is thus the cause of death in about 10%, and of disability in slightly more cases of aneurysmal SAH. The extent of the problem has not changed significantly over three decades.


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        • Adams CBT
        Vasospasm: occurrence in conditions other than subarachnoid hemorrhage from a bleeding aneurysm.
        in: Wilkins RH Cerebral arterial spasm. Williams and Wilkins, Baltimore1980: 471
        • Wilkins RH
        Trauma-induced cerebral vasospasm.
        in: Wilkins RH Cerebral arterial spasm. Williams and Wilkins, Baltimore1980: 472-475
        • Kwak R
        • Niizuma H
        • Ohi T
        • Suzuki J
        Angiographic study of cerebral vasospasm following rupture of intracranial aneurysms: Part 1. Time of the appearance.
        Surg Neurol. 1979; 11: 257-262
        • Griffith HB
        • Cummins BH
        • Thomson JLG
        Cerebral arterial spasm and hydrocephalus in leaking arterial aneurysms.
        Neuroradiology. 1972; 4: 212-214
        • Saito I
        • Ueda Y
        • Sano K
        Significance of vasospasm in the treatment of ruptured intracranial aneurysms.
        J Neurosurg. 1977; 47: 412-429
        • Hamer J
        • Penzholz H
        • Götte B
        Time course and clinical significance of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
        in: Schiefer W Klinger M Brock M Advances in Neurosurgery 9. Springer-Verlag, Berlin1981: 197-200
        • Kassell NF
        • Boarini DJ
        • Adams Jr, HP
        • et al.
        Overall management of ruptured aneurysm: comparison of early and late operation.
        Neurosurgery. 1981; 9: 120-128
        • Kim H
        • Mizukami M
        • Kawase T
        • Takemae T
        • Araki G
        Time course of vasospasm: its clinical significance.
        Neurol Med Chir. 1979; 19: 95-102
        • Pasqualin A
        • Rosta L
        • Da Pian R
        • Cavazzani P
        • Scienza R
        Role of computed tomography in the management of vasospasm after subarachnoid hemorrhage.
        Neurosurgery. 1984; 15: 344-353
        • Saito I
        • Sano K
        Vasospasm after aneurysm rupture: incidence, onset, and course.
        in: Wilkins RH Cerebral arterial spasm. Williams and Wilkins, Baltimore1980: 294-301
        • Ahyai A
        • Rittmeyer K
        • Spoerri O
        Differentialdiagnostische ervägungen beim bild des angiospasmus.
        in: Voth D Glees P Der zerebrale Angiospasmus. Walter de Gruyter, Berlin1984: 293-297
        • Miller CA
        • Hunt CD
        • Hunt WE
        Course of vasospasm following subarachnoid haemorrhage. Serieal angiography, its relation to timing and perioperative care.
        in: Auer LM Timing of aneurysm surgery. Walter de Gruyter, Berlin1985: 445-450
        • Sengupta RP
        • McAllister VL
        Subarachnoid haemorrhage.
        in: Springer-Verlag, Berlin1986: 269-281
        • White RP
        Vasospasm. II. Clinical considerations.
        in: Fox JL Intracranial Aneurysms. Springer-Verlag, New York1983: 250-271
        • Schneck SA
        On the relationship between ruptured intracranial aneurysm and cerebral infarction.
        Neurology. 1964; 14: 691-702
        • Pickard JD
        • Murray GD
        • Illingworth R
        • et al.
        Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British Aneurysm Nimodipine Trial.
        Br Med J. 1989; 298: 636-642
        • Wijdicks EFM
        • Vermeulen M
        • Hijdra A
        • van Gijn J
        Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful?.
        Ann Neurol. 1985; 17: 137-140
        • Noterman J
        • d'Haens J
        • Brotchi J
        Bilan de trois ans de traitement chirurgical des anévrysmes intracrâniens.
        Acta Neurol Belg. 1986; 86: 243-259
        • Torner JC
        • Kassell NF
        • Haley Jr, EC
        The timing of surgery and vasospasm.
        Neurosurgery Clin N Am. 1990; 1: 335-347
        • Hunt WE
        • Hess RM
        Surgical risk as related to time of intervention in the repair of intracranial aneurysms.
        J Neurosurg. 1968; 28: 14-20
        • Nishigaya K
        • Nukui H
        • Kaneko M
        • Mitsuka S
        • Miyazawa N
        • Horikoshi T
        Surgical treatment in patients over 65 years of age with ruptured cerebral aneurysms.
        in: Presented at the Second International Workshop on Intracranial Aneurysms, Nagoya, Japan1989
        • Asahi S
        • Izawa M
        • Kagawa M
        Surgical treatment for cerebral aneurysms in aged patients. Report of 100 ruptured aneurysmal cases over 70 years of age.
        in: Presented at the Second International Workshop on Intracranial Aneurysms, Nagoya, Japan1989
        • Heros RC
        • Kistler JP
        Intracranial arterial aneurysm: an update.
        Stroke. 1983; 14: 628-631
        • Fisher CM
        • Roberson GH
        • Ojemann RG
        Cerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations.
        Neurosurgery. 1977; 1: 245-248
        • Kassell NF
        • Boarini DJ
        • Adams Jr, HP
        • et al.
        Overall management of ruptured aneurysm: comparison of early and late operation.
        Neurosurgery. 1981; 9: 120-128
        • Mohsen F
        • Pomonis S
        • Illingworth R
        Prediction of delayed cerebral ischaemia after subarachnoid haemorrhage by computed tomography.
        J Neurol Neurosurg Psychiatry. 1984; 47: 1197-1202
        • Weir BKA
        The incidence and onset of vasospasm after subarachnoid hemorrhage from ruptured aneurysm.
        in: Wilkins RH Cerebral Arterial Spasm. Williams and Wilkins, Baltimore1980: 302-305
        • Mickey B
        • Vorstrup S
        • Voldby B
        • Lindewald H
        • Harmsen A
        • Lassen NA
        Serial measurement of regional cerebral blood flow in patients with SAH using 133Xe inhalation and emission computerized tomography.
        J Neurosurg. 1984; 60: 916-922
        • Rivierez M
        • Dagreou F
        • Guggiari M
        • Ankri A
        • Crespo B
        • Philippon J
        Intérêt pronostique de l'activité fibrinolytique du L.C.R. dans les hémorragies méningées par rupture anévrysmale.
        Neurochirurgie. 1983; 29: 119-123
        • Rosenstein J
        • Suzuki M
        • Symon L
        • Redmond S
        Clinical use of a portable bedside cerebral blood flow machine in the management of aneurysmal subarachnoid hemorrhage.
        Neurosurgery. 1984; 15: 519-525
        • Rodriguez y Baena R
        • Gaetani P
        • Folco G
        • Vigano T
        • Paoletti P
        Arachidonate metabolites and vasospasm after subarachnoid haemorrhage.
        Neurol Res. 1986; 8: 25-32
        • Hashi K
        • Aoyama I
        • Nin K
        • Shimotake K
        Further trial of cisternal clot removal for severe subarachnoid haemorrhage.
        in: Auer LM Timing of Aneurysm Surgery. Walter de Gruyter, Berlin1985: 373-379
        • Peerless SJ
        • Nemoto S
        • Drake G
        Acute surgery for ruptured posterior circulation aneurysms.
        in: 2nd ed. Advances and Technical Standards in Neurosurgery. Vol 15. Springer-Verlag, Vienna1987: 115-129
        • Segawa H
        • Saito I
        • Okada T
        • et al.
        Efficacy of intracisternal papaverine on symptomatic vasospasm.
        in: Wilkins RH Cerebral Vasospasm. Raven Press, New York1988: 433-441
        • Tsementzis SA
        • Hitchcock ER
        • Meyer CHA
        Benefits and risks of antifibrinolytic therapy in the management of ruptured intracranial aneurysms. A double-blind placebo-controlled study.
        Acta Neurochir. 1990; 102: 1-10
        • Vermeulen M
        • Lindsay KW
        • Murray GD
        • et al.
        Antifibrinolytic treatment in subarachnoid hemorrhage.
        N Engl J Med. 1984; 311: 432-437
        • Haley Jr, EC
        • Torner JC
        • Kassell NF
        Antifibrinolytic therapy and cerebral vasospasm.
        Neurosurgery Clin N Am. 1990; 1: 349-356
        • Ameen AA
        • Illingworth R
        Anti-fibrinolytic treatment in the pre-operative management of subarachnoid haemorrhage caused by ruptured intracranial aneurysm.
        J Neurol Neurosurg Psychiatry. 1981; 44: 220-226
        • Maurice-Williams RS
        Prolonged antifibrinolysis: an effective non-surgical treatment for ruptured intracranial aneurysms?.
        Br Med J. 1978; 1: 945-947
        • Girvin JP
        The use of antifibrinolytic agents in the preoperative treatment of ruptured intracranial aneurysms.
        Trans Am Neurol Assoc. 1973; 98: 150-151
        • Maroon JC
        • Nelson PB
        Hypovolemia in patients with subarachnoid hemorrhage: therapeutic implications.
        Neurosurgery. 1979; 4: 223-226
        • Kudo T
        • Suzuki S
        • Iwabuchi T
        Importance of monitoring the circulating blood volume in patients with cerebral vasospasm after subarachnoid hemorrhage.
        Neurosurgery. 1981; 9: 514-520
        • Fujita S
        Computed tomographic grading with Hounsfield number related to delayed vasospasm in cases of ruptured cerebral aneurysm.
        Neurosurgery. 1985; 17: 609-612
        • Richardson JTE
        Arterial spasm and recovery from subarachnoid haemorrhage.
        J Neurol Neurosurg Psychiatry. 1976; 39: 1134-1136
        • Borges G
        • Facure NO
        • Facure JJ
        Klinische Wechselbeziehung der Gefässspasmen in der Chirurgie der Aneurysmen.
        Zentralbl Neurochir. 1987; 48: 219-221
        • Kawamura J
        • Haneda H
        Clinical considerations on the so-called cerebral vasospasm and its classification.
        Neurol Med Chir. 1964; 6: 50
        • Rousseaux P
        • Scherpereel B
        • Bernard MH
        • Graftieaux JP
        • Guyot JF
        Fever and cerebral vasospasm in ruptured intracranial aneurysms.
        Surg Neurol. 1980; 14: 459-465
        • Bonnal J
        • Stevenaert A
        • Brotchi J
        • Dethier JC
        Bilan de neuf ans d'expérience de la chirurgie des anévrysmes artériels intracrâniens.
        Acta Neurol Belg. 1974; 74: 337-355
        • Artiola i Fortuny L
        • Prieto-Valiente L
        Long-term prognosis in surgically treated intracranial aneurysms. Part 1: Mortality.
        J Neurosurg. 1981; 54: 26-34
        • Post KD
        • Flamm ES
        • Goodgold A
        • Ransohoff J
        Ruptured intracranial aneurysms. Case morbidity and mortality.
        J Neurosurg. 1977; 46: 290-295
        • Handa H
        • Ohta T
        • Kawamura J
        • Osaka K
        • Kajikawa H
        Filling-abnormality (so-called vasospasm) following rupture of intracranial aneurysm: its classification and relation between different patterns and their prognosis.
        Neurol Med Chir. 1967; 9: 86-89
        • Sano K
        • Tamura A
        A proposal for grading of subarachnoid haemorrhage due to aneurysm rupture.
        in: Auer LM Timing of aneurysm surgery. Walter de Gruyter, Berlin1985: 3-7
        • Pasqualin A
        • Cavazzani P
        • Scienza R
        • Licata C
        • Da Pian R
        Clinical features of cerebral vasospasm following early surgery for intracranial aneurysms.
        in: Auer LM Timing of aneurysm surgery. Walter de Gruyter, Berlin1985: 451-459
        • Nibbelink DW
        • Torner JC
        • Henderson WG
        Intracranial aneurysms and subarachnoid hemorrhage: report on a randomized treatment study. IV-A. Regulated bed rest.
        Stroke. 1977; 8: 202-218
        • Aoyagi N
        • Hayakawa I
        • Takemura N
        • Tsuchida T
        • Furihata S
        • Sasaki M
        Analysis of 223 cases of intracranial ruptured aneurysms: with special reference to re-rupture of the intracranial aneurysms.
        Neurol Surg. 1983; 11: 63-71
        • Fujiwara S
        • Matsubara T
        • Hachisuga S
        Results of microsurgical management of ruptured intracranial aneurysms.
        Acta Neurochir. 1983; 68: 227-237
        • Krayenbühl HA
        • Yasargil MG
        • Flamm ES
        • Tew Jr, JM
        Microsurgical treatment of intracranial saccular aneurysms.
        J Neurosurg. 1972; 37: 678-686
        • Rasmussen P
        • Busch H
        • Haase J
        • et al.
        Intracranial saccular aneurysms. Results of treatment in 851 patients.
        Acta Neurochir. 1980; 53: 1-17
        • Rosenorn J
        • Eskesen V
        • Schmidt K
        • et al.
        Clinical features and outcome in 1076 patients with ruptured intracranial saccular aneurysms: a prospective consecutive study.
        Br J Neurosurg. 1987; 1: 33-45
        • Nibbelink DW
        • Sahs AL
        • Knowler LA
        Antihypertensive and antifibrinolytic medications in subarachnoid hemorrhage and their relation to cerebral vasospasm. A report of the cooperative aneurysm study.
        in: Smith RR Robertson JT Subarachnoid Hemorrhage and Cerebrovascular Spasm. Charles C Thomas, Springfield1975: 177-205
        • Kassell NF
        • Torner JC
        • Haley Jr, EC
        • Jane JA
        • Adams HP
        • Kongable GL
        The international cooperative study on the timing of aneurysm surgery. Part 1: Overall management results.
        J Neurosurg. 1990; 73 (and participants): 18-36
        • Wilkins RH
        • Alexander JA
        • Odom GL
        Intracranial arterial spasm: a clinical analysis.
        J Neurosurg. 1968; 29: 121-134
        • Millikan CH
        Cerebral vasospasm and ruptured intracranial aneurysm.
        Arch Neurol. 1975; 32: 433-449
        • Lee K-C
        Early operation for ruptured intracranial aneurysm: pre- and intraoperative care.
        in: Presented at the Eighth Asian-Australasian Congress of Neurosurgery, Seoul, Korea1991
        • Kelly PJ
        • Gorten RJ
        • Grossman RG
        • Eisenberg HM
        Cerebral perfusion, vascular spasm, and outcome in patients with ruptured intracranial aneurysms.
        J Neurosurg. 1977; 47: 44-49
        • Kelly PJ
        • Gorten RJ
        • Rose JE
        • Grossman RG
        • Eisenberg HM
        Radionuclide cerebral angiography and the timing of aneurysm surgery.
        Neurosurgery. 1979; 5: 202-207
        • Artiola i Fortuny L
        • Prieto-Valiente L
        Long-term prognosis in surgically treated intracranial aneurysms. Part 2: Morbidity.
        J Neurosurg. 1981; 54: 35-43
        • Allcock JM
        • Drake CG
        Postoperative angiography in cases of ruptured intracranial aneurysm.
        J Neurosurg. 1963; 20: 752-759
        • Sindou M
        • Debourdeau Ph
        • Benhamouda H
        Prognostic factors in the surgical timing of ruptured intracranial aneurysms.
        in: Sugita K Shibuya M Intracranial Aneurysms and Arteriovenous Malformations. Nagoya University COOP Press, Nagoya1990: 45-53
        • Medlock MD
        • Dulebohn SC
        • Elwood PW
        Prophylactic hypervolemia without calcium channel blockers in early aneurysm surgery.
        Neurosurgery. 1992; 30: 12-16
        • Fleiss JL
        Statistical Methods for Rates and Proportions.
        2nd ed. Wiley, New York1981 (ch 10)
        • Jennett B
        • Snoek J
        • Bond MR
        • Brooks N
        Disability after severe head injury: observations on the use of the Glasgow Outcome Scale.
        J Neurol Neurosurg Psychiatry. 1981; 44: 285-293
        • Mendenhall W
        • Scheaffer RL
        • Wackerly DD
        Mathematical Statistics with Applications.
        in: 3rd ed. Duxbury Press, Boston1986: 217-221
        • Campbell C
        • Fuller K
        Clinical perspective. Review of the disability rating scale.
        Aust Occ Ther J. 1989; 36: 220-225