Citation

Sorrentino ZA, Lucke-Wold BP, Laurent D, Quintin SS, Hoh BL. World Neurosurg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Elsevier Publishing)

DOI

10.1016/j.wneu.2023.11.135

PMID

38043741

Abstract

Traumatic subarachnoid hemorrhage (tSAH) is frequently co-morbid with traumatic brain injury (TBI), and may induce secondary injury through vascular changes such as vasospasm and subsequent delayed cerebral ischemia (DCI). While aneurysmal SAH is well studied with regards to vasospasm and DCI, less is known regarding tSAH and the prevalence of vasospasm and DCI, the consequences of vasospasm in this setting, when treatment is indicated, and which management strategies should be implemented. Herein, a systematic review of the literature was conducted for cases of symptomatic vasospasm in TBI patients, association with tSAH is reported, risks factors for vasospasm and DCI are summarized, and commonalities in diagnosis and management are discussed. Clinical characteristics and treatment outcomes of 38 cases across 20 studies were identified in which TBI patients with vasospasm underwent medical or endovascular management. Of the cases with available data for each category, average age was 48.7 ± 20.3 years (n=31), GCS at presentation 10.6 ± 4.5 (n=35), and 100% had tSAH (n=29). Symptomatic vasospasm indicative of DCI was diagnosed on average at post injury day 8.4 ± 3.0 days (n=30). 56.6% of cases (n=30) had a new ischemic change associated with vasospasm confirming DCI. Treatment strategies are discussed, with 11 of 12 endovascularly treated and 19 of 26 medically treated patients surviving to discharge. In summary, tSAH is associated with vasospasm and DCI in moderate and severe TBI, and patients with clinical and radiographic evidence of symptomatic vasospasm and subsequent DCI may benefit from endovascular or medical management strategies.

Language: en

Keywords

traumatic brain injury; delayed cerebral ischemia; subarachnoid hemorrhage; traumatic subarachnoid hemorrhage; vasospasm