In the context of hemorrhagic stroke, what is vasospasm?

In the context of hemorrhagic stroke, what is vasospasm?

• A. Sudden onset high blood pressure
• B. Bleeding into the ventricles
• C. Spasm of peripheral arteries causing limb ischemia
• D. Irritation from free blood in the brain causing delayed cerebral ischemia, typically occurring 3-21 days post-event

Answer: (D)

Vasospasm after a hemorrhagic stroke means cerebral arteries become irritated by blood in the subarachnoid space and constrict, leading to reduced blood flow and delayed brain ischemia. This irritation from blood breakdown products triggers smooth muscle contraction and inflammatory changes in the vessels, so the brain can become ischemic days after the initial bleed. It typically appears 3 to 21 days after the event, often peaking around days 5 to 7. This is distinct from a sudden rise in blood pressure, bleeding into the ventricles, or a peripheral vascular spasm that would affect limbs rather than the brain. In practice, patients may develop new neurological deficits or a drop in level of consciousness during this window, even after the bleed has been controlled. Monitoring with tools like transcranial Doppler helps detect rising flow velocities suggestive of vasospasm, and imaging can reveal new ischemic changes. Prevention and management focus on preserving cerebral perfusion and limiting delayed injury: using medications like nimodipine to improve outcomes, maintaining adequate blood pressure and volume to support cerebral blood flow, securing the source of bleeding, and, in severe cases, considering endovascular therapy to relieve the vessel narrowing.

Vasospasm after a hemorrhagic stroke means cerebral arteries become irritated by blood in the subarachnoid space and constrict, leading to reduced blood flow and delayed brain ischemia. This irritation from blood breakdown products triggers smooth muscle contraction and inflammatory changes in the vessels, so the brain can become ischemic days after the initial bleed. It typically appears 3 to 21 days after the event, often peaking around days 5 to 7.

This is distinct from a sudden rise in blood pressure, bleeding into the ventricles, or a peripheral vascular spasm that would affect limbs rather than the brain. In practice, patients may develop new neurological deficits or a drop in level of consciousness during this window, even after the bleed has been controlled. Monitoring with tools like transcranial Doppler helps detect rising flow velocities suggestive of vasospasm, and imaging can reveal new ischemic changes.

Prevention and management focus on preserving cerebral perfusion and limiting delayed injury: using medications like nimodipine to improve outcomes, maintaining adequate blood pressure and volume to support cerebral blood flow, securing the source of bleeding, and, in severe cases, considering endovascular therapy to relieve the vessel narrowing.