At the Cerebrovascular Center at Mount Sinai, our experts specialize in evaluating and treating cerebral vasospasm. Vasospasm occurs when a brain blood vessel spasms and the vessel wall becomes severely constricted, blocking blood flow. Vasospasm, which can lead to ischemic stroke, is a complication that can occur in the two weeks following a subarachnoid hemorrhage or brain aneurysm.
Who Is At Risk For Cerebral Vasospasms?
Factors that increase the risk for cerebral vasospasms include:
- Recent subarachnoid hemorrhage
- Recent ruptured brain aneurysm
Cerebral Vasospasms Symptoms
These effects may indicate a cerebral vasospasm:
- Neck stiffness
- Mild confusion
- Speech impairment
- Paralysis on one side of the body
- Severely impaired consciousness
- Classic cerebrovascular disease (stroke) symptoms
Our physicians closely monitor all patients recovering from treatment of a subarachnoid hemorrhage or brain aneurysm. Based on the patient’s vasospasm symptoms, our physicians may perform the following tests:
- Cerebral angiography: a test when x-rays are taken of the brain after a dye is injected into it through a catheter threaded through the groin; this is often the best way to detect vasospasms
- CT scan at the time of the subarachnoid hemorrhage or brain aneurysm can be helpful. Studies show that the amount of blood on the original CT scan can correlate with the likelihood of a vasospasm occurring. A new CT scan during the post-treatment period following a subarachnoid hemorrhage or brain aneurysm may also be indicated.
- Transcranial Doppler ultrasound: which is used to look at blood flow through the skull, is efficient, is non-invasive and can be done at bedside. It is often used to regularly follow at-risk patients for the development and progression of vasospasms.
- MRI (magnetic resonance imaging): can help to show how much of the brain tissue has been damaged by the vasospasm
Treatment Options for Vasospasm
At the Cerebrovascular Center, we carefully monitor patients recovering from treatment of subarachnoid hemorrhage or brain aneurysm for signs of developing cerebral vasospasm. Preventively, physicians may follow one or more of the following approaches:
- A preventive course of oral calcium channel blockers, which has shown promise in preventing vasospasm for those recovering subarachnoid hemorrhage and brain aneurysm
- In appropriate cases hypervolemic-hypertensive-hemodilution (HHH) therapy may be recommended, a process by which the patient’s fluids and blood concentration are carefully balanced to improve brain blood flow
If a developing vasospasm is suspected, physicians may use one or more of the following strategies:
- A vasodilating agent, delivered to the site via catheter
- Transluminal angioplasty (often called balloon angioplasty), where a small balloon is attached to a catheter, which in turn is threaded through an area until it reaches the vasospasm site. The balloon is then inflated to break down the blockage.
Klingenstein Clinical Center, 1-North
1450 Madison Avenue
New York, NY 10029