Cerebral Vasospasm
A narrowing of the brain’s arteries that most often develops in the days after a subarachnoid hemorrhage, reducing blood flow and increasing the risk of delayed cerebral ischemia and stroke.
Quick Answer
Cerebral vasospasm is a narrowing of the arteries of the brain that most commonly develops in the days following a subarachnoid hemorrhage, usually from a ruptured aneurysm. The narrowing can reduce blood flow to the brain and contribute to delayed cerebral ischemia (DCI), which can cause new neurological deficits or stroke. Because vasospasm often develops while patients are recovering in the hospital, close neurological and blood-flow monitoring allows changes to be detected and treated quickly.
Key Takeaways
- Cerebral vasospasm is narrowing of the brain’s arteries that can reduce blood flow.
- It most often develops in the days after a subarachnoid hemorrhage.
- Reduced blood flow from vasospasm can contribute to delayed cerebral ischemia (DCI), which may cause new neurological deficits or stroke.
- Close neurological and blood-flow monitoring helps detect vasospasm early.
- Treatment focuses on maintaining blood flow to the brain and, when needed, directly treating narrowed arteries.
At a Glance
| What it is | Narrowing of brain arteries that can reduce blood flow |
|---|---|
| Most common setting | Days after a subarachnoid hemorrhage |
| Main risk | Delayed cerebral ischemia (DCI) and stroke |
| Monitoring | Neurological exams and transcranial Doppler ultrasound |
| Treatment | Medical management and, when needed, endovascular therapy |
| Key point | Early detection and treatment help protect blood flow to the brain |
Symptoms
Vasospasm typically develops several days after a subarachnoid hemorrhage, often between days four and fourteen. As blood flow to part of the brain drops, patients may develop new neurological symptoms such as confusion, decreased alertness, weakness, or speech difficulty. Because many affected patients are already in intensive care, subtle changes are watched for closely.
When it occurs outside the setting of a recent hemorrhage, symptoms reflect reduced blood flow to the affected area of the brain. Any new neurological change in a patient recovering from a subarachnoid hemorrhage is treated as possible vasospasm until proven otherwise.
Common Warning Signs
- New confusion or decreased alertness after a hemorrhage
- New weakness or numbness
- New speech difficulty
- Worsening headache
- A subtle decline in neurological status
When to Seek Care Promptly
- Any new neurological change after a subarachnoid hemorrhage
- New weakness, numbness, or speech difficulty
- Decreasing alertness
- Worsening headache with neurological signs
- Sudden decline in a recovering patient
Diagnosis
In patients recovering from a subarachnoid hemorrhage, vasospasm is watched for with frequent neurological examinations and transcranial Doppler ultrasound, which measures blood flow velocity in the brain arteries. A rise in velocity can signal developing narrowing.
When vasospasm is suspected, CT angiography, CT perfusion, or catheter angiography confirms the narrowing and assesses its effect on blood flow. Catheter angiography also allows treatment to be delivered at the same time if needed.
Treatment
Treatment of cerebral vasospasm focuses on maintaining adequate blood flow to the brain and preventing neurological injury during the high-risk period after a subarachnoid hemorrhage. Treatment depends on the severity of the vasospasm, changes in neurological function, and how well the patient responds to initial medical management.
Maintaining Blood Flow
Patients are monitored closely while medical management is used to support adequate blood flow to the brain and reduce the impact of vasospasm. Care may include careful fluid and blood-pressure management and medication during the high-risk period after a subarachnoid hemorrhage.
Intra-Arterial Medication
When vasospasm is severe or causing symptoms despite medical management, a catheter can be guided through the blood vessels to deliver medication directly into the narrowed arteries. This can help relax the artery and improve blood flow to the affected area of the brain.
Balloon Angioplasty
For selected areas of severe vasospasm, a small balloon may be guided into the narrowed artery and carefully inflated to widen the vessel and improve blood flow. Angioplasty may be considered when significant narrowing persists or requires more direct treatment.
Choosing the Right Approach
Treatment decisions are guided by neurological changes, the location and severity of arterial narrowing, blood-flow findings, and the patient’s response to medical management.
Why close monitoring matters: Vasospasm can change quickly during recovery from a subarachnoid hemorrhage. Frequent neurological assessment and blood-flow monitoring help the neurovascular and neurocritical care teams recognize when more aggressive treatment may be needed.
The Diagnosis-to-Treatment Pathway
1. High-risk period
Close monitoring begins after subarachnoid hemorrhage during the period when vasospasm may develop.
2. Neurological monitoring
Frequent neurological exams help identify new or worsening symptoms.
3. Blood-flow monitoring
Transcranial Doppler ultrasound and vascular imaging help detect arterial narrowing and changes in cerebral blood flow.
4. Medical management
Fluid, blood-pressure, and medication strategies are used to support adequate blood flow to the brain.
5. Endovascular treatment when indicated
Intra-arterial medication or balloon angioplasty may be used for severe or symptomatic vasospasm that requires more direct treatment.
6. Ongoing monitoring
Neurological exams and blood-flow monitoring continue as vasospasm improves and the high-risk period passes.
Frequently Asked Questions
Cerebral vasospasm is a narrowing of arteries in the brain that can reduce blood flow. It most commonly develops in the days after a subarachnoid hemorrhage, often caused by a ruptured brain aneurysm.
Vasospasm typically develops several days after the initial hemorrhage, which is why patients are closely monitored during recovery even after the source of the bleeding has been treated.
Delayed cerebral ischemia is a complication that can occur after subarachnoid hemorrhage and may cause new neurological deficits or stroke. Cerebral vasospasm can contribute to DCI by narrowing arteries and reducing blood flow to the brain.
Warning signs may include new weakness or numbness, difficulty speaking or understanding speech, confusion, increasing drowsiness, or a new severe headache. Because patients are often hospitalized when vasospasm develops, neurological changes can be evaluated quickly.
Frequent neurological examinations and transcranial Doppler ultrasound can help detect changes associated with vasospasm. CTA, MRA, CT perfusion, or catheter angiography may also be used to evaluate arterial narrowing and blood flow.
Treatment focuses on maintaining adequate blood flow to the brain. Medical management may include careful fluid and blood-pressure management and medication. More severe or symptomatic vasospasm may require endovascular treatment.
During an endovascular procedure, a catheter is guided through the blood vessels to the narrowed arteries. Medication can then be delivered directly into the affected vessels to help relax them and improve blood flow.
Balloon angioplasty may be considered for selected areas of severe vasospasm. A small balloon is guided into the narrowed artery and carefully inflated to widen the vessel and improve blood flow.
Specialists Who Treat Cerebral Vasospasm
Your care is provided by Atlantic Brain and Spine's neurovascular team, including fellowship-trained cerebrovascular and endovascular neurosurgeons.
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