Department of Radiology, University of Massachusetts, Worcester, MA, USA.
CNS Neurol Disord Drug Targets. 2013 Mar;12(2):233-41. doi: 10.2174/1871527311312020010.
Cerebral vasospasm is a common and serious complication of aneurysmal subarachnoid haemorrhage. Despite the improvements in treatment of aneurysmal subarachnoid haemorrhage (aSAH), cerebral vasospasm complicating aSAH has remained the main cause of morbidity and mortality. Subarachnoid haemorrhage (SAH)-induced vasospasm is a complex entity caused by vasculopathy, impaired autoregulation, and hypovolaemia, causing a regional reduction of cerebral brain perfusion which can then induce ischaemia. Cerebral vasospasm can present either asymptomatically detected only radiologically or symptomatically (delayed ischaemic neurologic deficit). The various diagnostic approaches include the use of transcranial doppler, digital subtraction angiography and multimodal computed tomography (CT) and magnetic resonance (MR) techniques. Although digital subtraction angiography is usually the gold standard for the diagnosis of cerebral vasospam, transcranial doppler is commonly the first-screening method for the detection of cerebral vasospam. The treatment of subarachnoid haemorrhage -induced vasospasm include the use of both medical and endovascular therapy. The aim of this review is to discuss the various current therapeutic options and future perspective measures for reducing cerebral vasospasm induced stroke after SAH.
颅内血管痉挛是蛛网膜下腔出血的常见且严重的并发症。尽管对颅内动脉瘤性蛛网膜下腔出血（aSAH）的治疗有所改善，但并发 aSAH 的颅内血管痉挛仍然是发病率和死亡率的主要原因。蛛网膜下腔出血（SAH）引起的血管痉挛是由血管病变、自动调节受损和低血容量引起的复杂实体，导致局部脑灌注减少，进而引起缺血。颅内血管痉挛可无症状，仅在影像学上检测到，也可出现症状（迟发性缺血性神经功能缺损）。各种诊断方法包括经颅多普勒、数字减影血管造影以及多模态计算机断层扫描（CT）和磁共振（MR）技术。尽管数字减影血管造影通常是颅内血管痉挛诊断的金标准，但经颅多普勒通常是检测颅内血管痉挛的首选筛查方法。蛛网膜下腔出血引起的血管痉挛的治疗包括使用药物和血管内治疗。本文旨在讨论目前治疗颅内血管痉挛的各种治疗选择和未来降低蛛网膜下腔出血后卒中风险的措施。
