Delayed cerebral ischemia

Last revised by Craig Hacking on 22 Feb 2019

Citation, DOI, disclosures and article data

Citation:

St-Amant M, Hacking C, Delayed cerebral ischemia. Reference article, Radiopaedia.org (Accessed on 20 Apr 2024) https://doi.org/10.53347/rID-58261

DOI:

https://doi.org/10.53347/rID-58261

Permalink:

https://radiopaedia.org/articles/58261

rID:

58261

Article created:

10 Feb 2018, Maxime St-Amant ◉

Disclosures:

At the time the article was created Maxime St-Amant had no recorded disclosures.

View Maxime St-Amant's current disclosures

Last revised:

22 Feb 2019, Craig Hacking ◉ ◈

Disclosures:

At the time the article was last revised Craig Hacking had no recorded disclosures.

View Craig Hacking's current disclosures

Revisions:

3 times, by 2 contributors - see full revision history and disclosures

Systems:

Central Nervous System

Synonyms:

Delayed cerebral ischemia (DCI) is a frequent complication of subarachnoid hemorrhage. It contributes substantially to the morbidity and mortality following subarachnoid hemorrhage. It is defined as symptomatic vasospasm related to subarachnoid hemorrhage or cerebral infarction demonstrated on imaging felt to be attributable to vasospasm ¹.

Although vasospasm is thought of as the main cause of DCI, other etiologies have been proposed since areas of acute cerebral infarction have been identified following subarachnoid hemorrhage despite mild or absent vasospasm ⁶. Hypovolemia, especially in the settings of dysfunctional vascular autoregulation, and iatrogenic etiologies (damage to arteries following embolization or clipping) have been proposed as potential causes.

Clinical presentation

DCI presents clinically as new focal neurological deficits or altered consciousness felt to be attributable to ischemia in the setting of vasospasm ^1,7.

Radiographic features

Typical features of acute cerebral infarction are seen on CT-scan and/or MRI. Vasospasm is also often seen on CTA, MRA or DSA. The two most common patterns are single cortical infarct (40%) and multifocal infarcts (often bilateral) distal to the ruptured aneurysm (50%) ⁵.

References

1. Jennifer A. Frontera, Andres Fernandez, J. Michael Schmidt, Jan Claassen, Katja E. Wartenberg, Neeraj Badjatia, E. Sander Connolly, Stephan A. Mayer. Defining Vasospasm After Subarachnoid Hemorrhage. (2009) Stroke. 40 (6): 1963. doi:10.1161/STROKEAHA.108.544700 - Pubmed
2. Mayberg MR, Batjer HH, Dacey R, Diringer M, Haley EC, Heros RC, Sternau LL, Torner J, Adams HP, Feinberg W. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. (1994) Stroke. 25 (11): 2315-28. Pubmed
3. Haley EC, Kassell NF, Torner JC. A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. (1993) Journal of neurosurgery. 78 (4): 537-47. doi:10.3171/jns.1993.78.4.0537 - Pubmed
4. Haley EC, Kassell NF, Torner JC, Truskowski LL, Germanson TP. A randomized trial of two doses of nicardipine in aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. (1994) Journal of neurosurgery. 80 (5): 788-96. doi:10.3171/jns.1994.80.5.0788 - Pubmed
5. Rabinstein AA, Weigand S, Atkinson JL, Wijdicks EF. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. (2005) Stroke. 36 (5): 992-7. doi:10.1161/01.STR.0000163090.59350.5a - Pubmed
6. Ibrahim GM, Weidauer S, Vatter H, Raabe A, Macdonald RL. Attributing hypodensities on CT to angiographic vasospasm is not sensitive and unreliable. (2012) Stroke. 43 (1): 109-12. doi:10.1161/STROKEAHA.111.632745 - Pubmed
6. Veldeman M, Höllig A, Clusmann H, Stevanovic A, Rossaint R, Coburn M. Delayed cerebral ischaemia prevention and treatment after aneurysmal subarachnoid haemorrhage: a systematic review. (2016) British journal of anaesthesia. 117 (1): 17-40. doi:10.1093/bja/aew095 - Pubmed