Radiographic Evaluation and Clinical Management of Cerebral Vasospasm

Krishna Amuluru; Kushal J Shah; Troy D Payner; Andrew J DeNardo; Daniel P Gibson; Charles G Kulwin; Daniel H Sahlein

doi:10.1016/j.nic.2025.04.006

Radiographic Evaluation and Clinical Management of Cerebral Vasospasm

Neuroimaging Clin N Am. 2025 Aug;35(3):383-395. doi: 10.1016/j.nic.2025.04.006.

Authors

Krishna Amuluru¹, Kushal J Shah², Troy D Payner², Andrew J DeNardo³, Daniel P Gibson³, Charles G Kulwin², Daniel H Sahlein³

Affiliations

¹ Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Division of Interventional Neuroradiology, Indianapolis, IN, USA. Electronic address: kamuluru@goodmancampbell.com.
² Department of Cerebrovascular Neurosurgery, Goodman Campbell Brain and Spine, Carmel, IN 46032, USA.
³ Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Division of Interventional Neuroradiology, Indianapolis, IN, USA.

PMID: 40634006
DOI: 10.1016/j.nic.2025.04.006

Abstract

Delayed cerebral ischemia (DCI) occurs 3-14 days after aneurysmal subarachnoid hemorrhage (aSAH) and involves secondary neurological deterioration. The term "DCI" is defined as focal neurological impairment lasting >1 hour, unrelated to other causes, and diagnosed via clinical assessment and imaging. Paradigm shifts have taken emphasis away from merely vasospasm towards a pathophysiology related to microcirculatory dysfunction, inflammation, and impaired autoregulation. Clinical examination, multimodality monitoring and various imaging/perfusion imaging aid in detection. Nimodipine remains the only proven treatment to affect outcomes. Endovascular intervention is considered for cases refractory to hemodynamic management, and involves intra-arterial vasodilators, and modern interventional devices.

Keywords: Angioplasty; CTA; Cerebral aneurysm; Delayed cerebral ischemia; Intra-arterial vasodilators; Magnetic resonance angiography; Perfusion; Subarachnoid hemorrhage; Vasospasm.

Publication types

Review

MeSH terms

Cerebral Angiography* / methods
Humans
Subarachnoid Hemorrhage* / complications
Subarachnoid Hemorrhage* / diagnostic imaging
Vasospasm, Intracranial* / diagnostic imaging
Vasospasm, Intracranial* / etiology
Vasospasm, Intracranial* / therapy