Intracranial vasospasm

Fatal cerebellar infarction has been described in a 39-year-old man who took sumatriptan 100 mg for an acute attack of migraine. The cerebellar infarct was diagnosed at autopsy, and intracranial vasospasm was thought to be the likely mechanism (18). It should be noted that stroke has also been documented in patients with migraine, independently of drug treatment. 

Suction thrombectomy or thromboaspiration through either a microcatheter or a guiding catheter may be an option for fresh nonadhesive clot. As discussed above, aspiration devices have the advantage of causing less embolic events and vasospasm however, the more complex design of these devices makes them more difficult to navigate into the intracranial circulation. 

Coronary vasospasm Intracranial hemorrhage or Stroke Ingestion of sympathomimetic agents Direct myocardial damage Cardiac contusion Direct current cardioversion Cardiac infiltrative disorders Chemotherapy Myocarditis Pericarditis... 

After subarachnoid hemorrhage vasospasm is a common complication that results from irritation of the intracranial vasculature by subarachnoid blood. Vasospasm may lead to delayed cerebral ischemia and ischemic strokes, up to several weeks after the initial hemorrhage. There is preliminary evidence that inflammation plays a role in vasospasm after subarachnoid hanorrhage (Nilupul Perera et al., 2006 Qatterbuck et al., 2003), and anti-inflammatory strategies have been shown to prevent vasospasm in experimental stroke models (Nilupul Perera et al., 2006). 

Subarachnoid hemorrhage (SAH) is most commonly caused by rupture of an intracranial aneurysm. It can produce vasospasm that may cause ischemia and infarction. Currently, vasospasm has surpassed rebleeding as the most important complication after rupture of an aneurysm. Vasospasm due to SAH is thought to occur in the majority of cases of SAH (angiographic vasospasm is detectable in perhaps as many as 60-70% of patients after subarachnoid hemorrhage), but is symptomatic only in about a third of this population [81]. Symptomatic vasospasm carries a 15% to 20% risk of stroke or death. Vasospasm peaks around 1 week after SAH, but it can be seen as early as 3 days or as late as 3 weeks after the initial event [82], The underlying mechanisms are not understood, but vasospasm is clearly related to the amount of blood and its location in the subarachnoid space. Clinical symptoms generally develop slowly over a period of several hours to 1 or 2 days however, clinical evolution can be rapid in the onset with a stroke-like presentation [81, 82]. 

Sensory systems Eyes A 55-year-old woman developed choroidal infarction with permanent visual loss after intracranial irrigation with papaverine 3 ml (30 mg/ml), used to prevent postoperative vasospasm after surgical clipping of a left middle cerebral artery aneurysm [161 ]. 

Various nondetachable balloons are available for temporary vessel occlusion, angioplasty for vasospasm therapy or remodelling techniques for broad based aneurysms. Larger vessels like the carotid or vertebral artery can be occluded with a double lumen balloon catheter, i.e. Meditech (Cook). For intracranial angioplasty and remodeling smaller, more flexible balloons, like the Hyperglide (MTI), Eclipse (Balt), or the Copernic (Balt) are required. Additionally to these balloons tbe Hyperform microballoon (MTI) can be used for remodelling technique. 

Condette-Auliac S, Bracard S, Anxionnat R, Schmitt E, Lacour JC, Braun M, Meloneto J, Cordebar A, Yin L, Picard L (2001) Vasospasm after subarachnoid hemorrhage interest in diffusion-weighted MR imaging. Stroke 32 1818-1824 Conway JE, Hutchins GM, Tamargo RJ (1999) Marfan syndrome is not associated with intracranial aneurysms. Stroke 30 1632-1636... 

Nelson PK (1998) Neurointerventional management of intracranial aneurysms. Neurosurg Clin North Am 9 879-895 Nelson PK, Levy DI (2001) Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery medium-term angiographic and clinical followup in 22 patients. AJNR Am J Neuroradiol 22 19-26 Newell DW, Elliott JP, Eskridge JM, Winn HR (1999) Endovascular therapy for aneurysmal vasospasm. Grit Care Clin 15 685-699, v... 

Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86 475-482 Vora YY, Suarez-Almazor M, Steinke DE, Martin ML, Findlay JM (1999) Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 44 1237-1247 discussion 1247-1248... 

Sasaki, T., Tanishima, T., Asano, T., 1979 Significance of lipid peroxidation in the genesis of chronic vasospasm following rupture of an intracranial aneurysm. Acta Neurochir. (Wien) (Suppl. 28), 536-540. 

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