Advanced concepts in the management of cerebral vasospasm associated with aneurysmal subarachnoid hemorrhage.

Despite advances in the diagnosis and surgical treatment of aneurysmal subarachnoid hemorrhage (SAH), the morbidity and mortality rates remain disturbingly high. In those patients that survive the initial event, deaths due to re-bleeding have been reduced as a result of a trend to earlier surgical repair of the aneurysm. Unfortunately, a large percentage of patients go on to die or become permanently disabled from cerebral infarction as a consequence of vasospasm. The exact mechanisms that contribute to the development of cerebral vasospasm in these patients continue to elude researchers. The pathological processes implicated in the vasospasm phenomenon will be described. Even though no single pharmacological agent or treatment protocol has been identified that prevents or reverses this deadly complication, a number of promising intervention strategies are being employed in the critical care setting. These will be explored in light of the most current research findings. Clearly, early detection and prompt treatment are vital if the outcomes for persons suffering aneurysmal SAH are to improve. A sound knowledge base, well-developed assessment and clinical reasoning skills, and a deeper understanding of the pathological processes and treatment objectives will assist the neuroscience practitioner to more ably care for these most challenging patients.