Vasospasm differential diagnosis

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Radiological intracranial arterial vasospasm affecting large and medium vessels of the circle of Willis occur most commonly secondary to ruptured cerebral aneurysms occurs. The peak incidence of cerebral vasospasm is at day 7 post the initial ictus of the Subarachnoid Hemorrhage. This can present as altered level of consciousness, and /or new neurological deficit. Once suspected, other factors included in the differential diagnosis should be worked up. The work up should include:

  1. Rebleeding - rule out via Head CT
  2. Hydrocephalus - rule out via Head CT
  3. Cerebral edema - rule out via Head CT
  4. Hyponatremia or other metabolic disturbances - rule out via CMP
  5. Infection - rule out via vitals, CBC
  6. Hypoxia - rule out via ABG
  7. Seizures - rule out via EEG if suspicion high (may also help rule in vasospasm - relative alpha and decreased power) (1,2)

References

(1) Vespa P M, Nuwer M R, Juhasz C, et al.: Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. EEG Clin Neurophys 103: 607-15, 1997.

(2) Labar D R, Fisch B J, Pedley T A, et al.: Quantitative EEG monitoring for patients with subarachnoid hemorrhage. EEG Clin Neurophys 78: 325-32, 1991. ular]]

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