Cerebral vasospasm is a condition seen between 4 and 8 days after a subarachnoid haemorrhage - never before 3 days. The result of vessel constriction is ischaemia, causing either generalised or focal deficits, which is a problem particularly in the higher grades of SAH.
The mechanism is unclear - it may have something to do with the release of oxygenated haemoglobin into the tissues, resulting in free radical formation and cell damage. Vasospasm affects the intradural vessels only.
Whatever the mechanism, vasospasm is seen radiologically in 30 to 40% of patients after an SAH, but clinically in only 10 to 15%.
The treatment is with nimodipine, after clipping, with hyperperfusion and hypertension to preserve oxygenation for 7 to 10 days.
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