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Aneurysmal SAH Induced Vasospasm: Pathogenesis and Management

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Endovascular Surgery of Cerebral Aneurysms

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Abstract

Introduction: Vasospasm remains a major cause of poor outcome after subarachnoid hemorrhage (SAH) following rupture of intracranial aneurysms. The pathogenesis still remains misty due to its complexity even though a lot of progress has been made in understanding various causative mechanisms through intense clinical and experimental research.

Method: Study carried out by a review of English literature on topics related to pathogenesis and management of post SAH induced vasospasm.

Result: Evidence-based information available points toward multifactorial biochemical phenomena instigated by Ferrous Hemoglobin which revolve around:

  1. (a)

    Concept of early brain injury and evidence of cortical spreading depression

  2. (b)

    Effect of ischemia in pre-vasospasm period and blood–brain barrier disruption.

  3. (c)

    Role of Nitric oxide (NO), Endothelin-1 levels, and oxidative stress on smooth muscle cells.

  4. (d)

    Changes induced by free radical production, lipid peroxidation, and alteration of ionic channels.

  5. (e)

    Differential upregulation of genes.

Conclusion: To date the understanding of pathophysiology of delayed vasospasm has made significant stride for which the role of research using animal models cannot be overemphasized. The treatment of this complex condition still remains vague.

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    Ashis Pathak

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    **anli Lv

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Pathak, A. (2022). Aneurysmal SAH Induced Vasospasm: Pathogenesis and Management. In: Lv, X. (eds) Endovascular Surgery of Cerebral Aneurysms. Springer, Singapore. https://doi.org/10.1007/978-981-16-7102-9_2

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