Prevention and treatment of cerebral vasospasm after aneurysmalsubarachnoid hemorrhage

Background. Cerebral vasospasm is the most serious complication of subarachnoid hemorrhage. It can be defined as deferred and self-limited condition whose severity is linked to the volume, solidity, prolonged presence and location of subarachnoid blood. Almost 70% of these patients have angiographic manifestation of vasospasm, and circa 50% of these patients experience neurological deficits. The purpose of this article is to concentrate on the current progress and prospective approaches in the prevention and treatment of cerebral vasospasm after aneurismal subarachnoid hemorrhage. Materials and methods. A thorough literature search through the Medline and Ebscodatabases was performed. Original investigations, meta-analyses and reviews from the past 10 years, with accessible full-texts, in the English language, were selected. Prevention and treatment. The main medical approach for prevention of vasospasm includes upkeep of normal blood circulation level and oral Nimodipine. The only type of treatment for cerebral vasospasm, which is recognized at present, is induced hypertension with the maintenance of euvolemia. Percutaneous transluminal angioplasty and/or selective intra-arterial vasodilator therapy are recommended in patients with symptomatic cerebral vasospasm, especially in those without quick response to hypertensive therapy. Conclusion. Novel approaches with immunomodulators, anesthetics, hypothermia, acupuncture, neuroprotective agents and multimodal treatment regimens are under active development and hold promise in the treatment of vasospasm in the coming years.