====== Delayed cerebral ischemia ======

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===== Definition =====

Delayed development of a neurological deficit, decline in Glasgow coma scale of at least 2 points, and/or cerebral infarction unrelated to aneurysm treatment or other causes. DCI is an umbrella term that encompasses a number of clinical entities including [[symptomatic vasospasm]], [[delayed ischemic neurological deficit]] (DIND), and asymptomatic delayed cerebral infarction
((Washington CW, Zipfel GJ. Detection and monitor- ing of vasospasm and delayed cerebral ischemia: a review and assessment of the literature. Neurocrit Care. 2011; 15:312–317)).

===== Etiology =====
see [[Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage]]


===== Prediction =====

[[Delayed cerebral ischemia prediction]]

===== Pathogenesis =====

see [[Delayed cerebral ischemia pathogenesis]].

===== Diagnosis =====

[[Delayed cerebral ischemia diagnosis]].

===== Complications =====
delayed cerebral ischemia (DCI) which can produce [[delayed ischemic neurologic deficit]] (DIND), usually attributed to [[vasospasm]]. Typically does not occur until several days following [[SAH]]


===== Prevention =====

see [[Delayed cerebral ischemia prevention]]. 

===== Treatment =====

[[Delayed cerebral ischemia Treatment]]









===== Outcome =====

[[Delayed cerebral ischemia outcome]].

===== Clinical trials =====
Enrolling patients in a [[randomized trial]] on a treatment strategy for DCI proved unfeasible: only 1 out of 25 admitted and 1 out of 14 eligible patients could eventually be randomized. These rates, caused by a large proportion of ineligible patients, a small proportion of patients providing [[informed consent]], and a large proportion of patients with contraindications for treatment, can be used to make sample size calculations for future randomized trials in DCI or otherwise critically ill patients. Facilitating informed consent through improved provision of information on risks, possible benefits, and study procedures may result in improved enrolment
((Gathier CS, van der Jagt M, van den Bergh WM, Dankbaar JW, Rinkel GJE, Slooter AJC; HIMALAIA Study Group. Slow recruitment in the HIMALAIA study: lessons for future clinical trials in patients with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage based on feasibility data. Pilot Feasibility Stud. 2022 Aug 30;8(1):193. doi: 10.1186/s40814-022-01155-4. PMID: 36042527.)).

===== Case series =====

[[Delayed cerebral ischemia case series]].