Frontera et al compared 4 different definitions for vasospasm that occurs after subarachnoid hemorrhage (SAH). A patient with cerebral damage following SAH-associated vasospasm may have a worse prognosis. The authors are from Mount Sinai School of Medicine and Columbia University in New York City.


Different criteria for vasospasm:

(1) symptomatic

(2) delayed cerebral ischemia (DCI)

(3) angiographic

(4) transcranial Doppler (TCD)


Symptomatic vasospasm - all of the following:

(1) one or both of the following:

(1a) development of new focal neurological signs

(1b) deterioration in the level of consciousness

(2) attributed to vasospasm-associated ischemia

(3) exclusion of other causes


Delayed Cerebral Ischemia - at least one of the following:

(1) symptomatic vasospasm (above)

(2) appearance of a new cerebral infarct on CT or MRI attributable to vasospasm


Angiographic vasospasm - both of the following:

(1) moderate-to-severe arterial narrowing on digital subtraction angiography

(2) exclusion of atherosclerosis, catheter-induced spasm, or vessel hypoplasia


Transcranial Doppler vasospasm: mean flow velocity in any vessel > 120 cm/sec.


The authors found that:

(1) delayed cerebral ischemia (DCI) was the only definition associated with death or severe disability at 3 months after SAH.

(2) DCI and symptomatic vasospasm were associated with disability, cognitive impairment and poor quality of life.

(3) Neither angiographic nor TCD was associated with clinical outcome.


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