Cerebral vasospasm is a sudden narrowing of cerebral arteries caused by vasospasm. This can lead to an insufficient supply of oxygen to the brain. Treatment is often difficult.
What is cerebral vasospasm?
Cerebral vasospasm is characterized by vascular spasm of cerebral arteries. One of the main causes is the so-called subarachnoid hemorrhage. But poisoning, drug abuse and drug consumption can also lead to this vascular spasm. The result of the cerebral vasospasm can be a cerebral infarction (stroke) due to an insufficient supply of oxygen. For meanings of hypochondria, please visit polyhobbies.com.
Here, an ischemic stroke is spoken of as opposed to a hemorrhagic cerebral infarction caused by cerebral hemorrhage. Cerebral vasospasm can last for several weeks and is difficult to treat. The consequences of this vascular spasm depend on its strength.
It can be fatal or cause severe disability. However, more harmless courses are also possible. In any case, cerebral vasospasm is a serious complication of subarachnoid hemorrhage, which worsens the prognosis of cerebral hemorrhage.
Causes
In most cases, cerebral vasospasm develops as part of a subarachnoid hemorrhage. This is bleeding from a blood vessel in the arachnoid (spider web) of the brain into the cerebrospinal fluid. The bleeding is usually the result of a congenital vascular malformation in the form of an aneurysm.
Substances are produced during hemolysis of the blood which presumably stimulate cramping of the cerebral arteries. Other diseases and poisoning can also lead to a vascular spasm of the cerebral arteries. An example is poisoning with ergot alkaloids ( ergotism ). Substances such as methamphetamine or cocaine also pose a risk.
For this reason, drug abuse often causes cerebral vasospasms. The same applies to medical measures involving drug treatment. The exact mechanism by which vascular spasm develops is not yet known. On the one hand, there is the assumption that the substances produced during hemolysis of the blood after a subarachnoid hemorrhage cause the arteries to contract.
These substances are prostaglandins and serotonin. They have a vasoconstrictive effect. Another reason discussed is the increased binding of NO by the degradation products of hemolysis. NO (nitric oxide) is known as a vasodilating substance. The lack of NO promotes the constriction of the corresponding arteries.
Inflammatory reactions at the site of bleeding could also contribute to vasospasm. Subarachnoid hemorrhage is already a so-called hemorrhagic stroke. Cerebral vasospasm is an additional complication that depends on the amount of blood. It can in turn lead to a secondary ischemic stroke.
Symptoms, Ailments & Signs
Similar symptoms appear in both the underlying disease and the actual cerebral vasospasm. The main symptom is a devastating headache that can lead to unconsciousness. There are also pathological restlessness, nausea, vomiting, states of confusion, sensitivity to light or noise.
Over a period of several weeks, severe headache attacks with devastating headaches occur again and again, which are interrupted by less severe headaches. In very severe cases, a secondary ischemic stroke develops with paralysis and other neurological deficits.
If a cerebral vasospasm occurs as part of a subarachnoid hemorrhage, then this usually takes place from the fourth day after the onset of bleeding. In this case, it is a complication that worsens the general condition and prognosis of the patient.
Diagnosis & course of disease
Cerebral vasospasm can be detected by angiography. Angiography is a radiological representation of blood and lymphatic vessels. Contrast agents are injected and X-rays of the blood vessels are taken.
At present, angiography is still superior to CT and MRI examinations in terms of vascular imaging because it has been carried out for a long time and has therefore been perfected. After a subarachnoid hemorrhage, ultrasound scans are also performed within the first ten days to quickly detect impending cerebral vasospasm.
There are no side effects with this method. If all symptoms point to a subarachnoid hemorrhage, but the CT scans do not bring a clear result, a lumbar puncture (collection of cerebrospinal fluid) can be performed. The liquor is then examined for blood admixtures.
Complications
Cerebral vasospasm is a complication that can occur as a result of cerebral hemorrhage (subarachnoid hemorrhage), poisoning, drug abuse or certain medical measures. It is a vascular spasm of arterial cerebral vessels. The corresponding blood vessels contract and endanger the blood supply to the brain.
This can lead to the death of certain areas of the brain. In this case, we speak of a cerebral infarction or ischemic stroke. A cerebral vasospasm therefore always worsens the general condition and the prognosis of the underlying disease. There are diseases with longer phases in which even several cerebral vasospasms can occur.
This applies, among other things, to subarachnoid hemorrhage in the brain. In this case, the spasms are triggered by the hemolysis of the blood that has entered the subarachnoid space. However, the contraction of the arteries can only be treated poorly. If there is a risk of cerebral vasospasm, the drug nimodipine is usually used to relax the vascular muscles. This can help prevent vasospasm.
But that doesn’t always work. However, if vasospasm has already occurred, it is advisable to wait until the spasm resolves on its own. It is usually not possible to foresee what possible late damage will occur. This depends, among other things, on the strength of the vasospasm, the affected brain regions and the size of the corresponding cerebral infarction.
When should you go to the doctor?
Sudden health impairments are a cause for concern. A doctor should be consulted if there are changes in behavior or personality within a short period of time. A sensitivity to external stimuli such as light or noise is also a warning signal from the organism. Medical tests are needed to determine the cause. Therefore, a doctor’s visit is necessary as soon as the affected person experiences changes in their state of health. An inner restlessness, nausea, vomiting or dizziness are further signs of an existing illness.
There is a need for action as quickly as possible if states of confusion set in, paralysis occurs or unconsciousness occurs. In acute cases, an emergency service must be alerted and those present must take first aid measures. Failure to do so can result in serious and life-threatening complications. Headaches, a feeling of pressure inside the head and disturbances in the general functioning of the organism must be presented to a doctor.
In the event of disorientation or changes in memory, the person concerned needs medical help. A feeling of illness, a general malaise or diffuse, unexplainable symptoms must also be examined and treated by a doctor. If there is an increase in existing health irregularities or if headaches in particular persist over a longer period of time, a doctor is needed. If the person concerned cannot fulfill his usual daily obligations, he should seek medical support.
Treatment & Therapy
An existing cerebral vasospasm is difficult to treat. Drug treatment with nimodipine is usually an option. The effectiveness for preventing vasospasm in subarachnoid hemorrhage is best, because the drug, as a so-called calcium antagonist, calms the muscular areas of the arteries.
Nimodipine is administered in the form of tablets or intravenously. The active ingredient accumulates in the brain due to its fat solubility. Should cerebral vasospasms nevertheless occur, there is still the option of using the so-called Triple-H therapy.
This therapy includes the three points hypervolemia, hypertension and hemodilution in order to avoid or suppress the contraction of the arterial blood vessels. This increases blood flow and blood pressure. Measures to thin the blood are also taken. Very strict control of the procedure is important to minimize effects on the respiratory and circulatory system.
Prevention
In many cases, cerebral vasospasm is unpredictable, particularly in the context of subarachnoid hemorrhage. These arise on the basis of congenital malformations of arterial blood vessels in the brain. However, possible risk factors include hypovolemia and high blood sugar levels.
In hypovolaemia, there is too little blood in the system due to loss of blood or fluid. High blood sugar levels can contribute to fluid loss through increased urination. Therefore, in general, a healthy lifestyle reduces not only the risk of diabetes but also the risk of cerebral vasospasm.
Aftercare
Follow-up treatment for cerebral vasospasm depends on the underlying disease that led to the condition. If bleeding in the brain was the cause of the cerebral vasospasm, it must be treated sustainably and permanently. In addition to the administration of blood-thinning medication, surgical interventions on the brain may also be necessary.
In addition, the brain should be imaged regularly using MRI and/or CT in order to be able to identify and treat any new abnormalities in the vessels in the brain at an early stage. If high blood pressure is present, it should also be treated with medication to reduce the risk of renewed bleeding in the brain. Smoking and alcohol consumption must be permanently stopped.
If poisoning has led to the development of cerebral vasospasm, it must be treated and then continuously monitored. Regular checks of the blood values are necessary for this, since renewed poisoning can only be detected in the blood. If medicines or drugs were the cause of the development of the cerebral vasospasm, then under no circumstances should they continue to be consumed.
Drugs should be discontinued permanently. If necessary, a switch to other medications must be made. If drug addiction is present, withdrawal is necessary to prevent renewed cerebral vasospasm. In addition, as a result of the cerebral vasospasm, chronic neurological disorders can arise that require separate neurological therapy.
You can do that yourself
In the case of cerebral vasospasm, self-help measures are not sufficient to initiate recovery or healing. Rather, cooperation with a doctor is necessary as soon as the first health impairments appear.
If there are general functional disorders, irregularities in cognitive processing or a diffuse feeling of discomfort, it is advisable to consult a doctor. As soon as disorders of brain activity become apparent, the relationship of trust between the person concerned, their relatives and the doctor treating them must be strengthened. It is important to adequately explain the existing disorders, their causes and the further course. Existing health knowledge should be deepened and expanded. The responsibility for this does not lie solely with the treating physicians.
The patient and their relatives should also independently look for ways to expand their basic medical knowledge. In many cases, important decisions about the further course of treatment have to be made within a short period of time. It is therefore particularly important to avoid disputes and disagreements and to work openly and cooperatively with the supervising specialists.
In addition, a healthy lifestyle is fundamentally beneficial for the further course. The diet should be controlled and optimized if possible. In addition, check-ups offered in advance should be taken at regular intervals. This increases the possibility of an early diagnosis.
