Cerebral Vasospasm
What is vasospasm?
It is thought that the blood from a ruptured aneurysm is irritating and causes the nearby blood vessels to spasm and narrow. This decreases blood flow to the brain which can result in damage or even death to parts of the brain. The doctors are sometimes able to predict if the patient has a higher chance of spasms and how severe the spasms will be based on the extent of the bleed. About two-thirds of patients will develop vasospasm after bleeding in to the subarachnoid space. About thirty percent of these vasospasms will cause symptoms.
When does it occur?
Vasospasm can begin 3 – 14 days after the first bleed. It is most common between 7 – 10 days. Patients may go “in and out” of vasospasm throughout the 21 days.
What are the signs and symptoms?
The patient will be closely monitored during this time. We are watching closely for signs of stroke. If a vasospasm occurs, the patient may be more drowsy or have weakness on one side of the body, trouble with speech, confusion, or trouble following commands.
How are they prevented?
The goal is to maintain an adequate blood supply to the brain by keeping the vessels open (dilated). To do this we use medicine, increase blood pressure, and increase blood volume. Patients are given a drug called nimodipine every 2 – 4 hours for 21 days to keep the vessels dilated. The patient will also receive large amounts of IV fluid. Blood pressure will be kept slightly higher than normal to prevent spasms.
How do we know if your loved one is “vasospasming?”
The doctors and nurses will be watching for clinical signs and symptoms. Transcranial Dopplers (TCD) might be scheduled on Monday, Wednesday, and Friday in the Neuro ICU or as the doctor feels they are needed. A technician will enter the patient’s room with a large machine. This will not hurt the patient and takes about 5 – 10 minutes. TCDs tell us the direction and speed of blood flow in the cerebral (brain) arteries. Thus, the doctor will be able to tell if the patient is having vasospasms simply by watching for changes in the blood flow.
A CTA (CT-Angiogram) may also be done. It provides a clearer picture of the vessels through use of a contrast injected into a vein.
How are vasospasms treated?
If spasms are detected, the patient will go to Interventional Radiology for an angiography. A neuroradiologist inserts a small catheter into an artery in the groin, which is then moved up through the body to the cerebral arteries. Verapamil® (a medicine that opens blood vessels) is injected into the vessels to open them up and increase blood flow to the brain. Vasospasms may or may not respond to treatment. They can be life threatening. Prognosis varies for each patient. Please feel free to ask your doctors and nurses any questions that you may have.
Reference
Clinical Practice of Neurological and Neurosurgical nursing: 2003, 5th edition, Joanne Hickey, p.538-539.
Missler, U. (2009, March). Cerebral vasospasm in patients suffering from aneurismal subarachnoid hemorrgage. Critical Care Medicine. 37 (3), 1150-1.
Zivin, J. A. (2007). Hemorrhagic Cerebrovascular Disease. In L. Goldman & D. Ausiello (Eds.), Cecil Medicine (23rd ed.). Retrieved from MDconsult database.
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Last Updated: 11/11/2011
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