Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage treatment
Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage prevention
see Delayed cerebral ischemia treatment
Aneurysmal subarachnoid hemorrhage treatment
Pharmacologically-induced hypertension combined with volume is the established first-line therapy for DCI; a good clinical response with reversal of the presenting deficit occurs in 70 % of patients. Medically refractory DCI, defined as failure to respond adequately to these measures, should trigger step-wise escalation of rescue therapy. Level 1 rescue therapy consists of cardiac output optimization, hemoglobin optimization, and endovascular intervention, including angioplasty and intra-arterial vasodilator infusion. In highly refractory cases, level 2 rescue therapies are also considered, none of which have been validated 1).
In 2012 Koenig published the Management of delayed cerebral ischemia after subarachnoid hemorrhage 2).