Cerebral vasospasm, the narrowing or constriction of a brain blood vessel or artery, most often occurs due to a ruptured brain aneurysm. Very rarely, cerebral vasospasm can occur when another blood vessel bleeds due to an abnormality such as an arteriovenous malformation, which is a defect in the circulatory system. According to "European Neurological Review" there are four groups of treatments to reduce vasospasm, often used in combination. No one treatment is always effective.
Prevention of Narrowing
Many methods are used to prevent or decrease the risk of cerebral vasospasm following a brain aneurysm. A blood clot can stimulate cerebral vasospasm, and thus one preventative treatment is its removal. A second technique is to stop inflammation in the brain using anti-inflammatory drugs and drugs that lower cholesterol.
Reversal of Narrowing
Techniques used to reverse narrowing include balloon angioplasty, which involves inflating a balloon in the constricted artery to widen it, and pharmacological angioplasty, which is the injection of a medication into the artery to widen it. Using vasodilators, such as nitric oxide and endothelin-1 inhibitors, can also reverse narrowing. Vasodilators work in a variety of ways to widen the constricted blood vessel.
Improvement of Brain Blood Flow
According to "Neurological Research," the most used treatment for cerebral vasospasm is hyperdynamic or triple-H therapy. Triple-H refers to hypervolemia, maintenance of circulating blood volume, hypertension, increased blood flow pressure, and hemodilution, decreased blood thickness. To achieve the three parts of triple-H therapy, a variety of drugs and techniques are used, all of which improve blood flow in instances of cerebral vasospasm.
Ischemic Protection
Ischemic protection refers to protecting parts of the brain from lack of blood flow and oxygen. The constriction of cerebral vasospasm means some areas of the brain do not get enough oxygen, which may cause the production of free radicals. Free radicals, molecules that damage cells, may be responsible for brain injury related to cerebral vasospasm. According to a 2008 review of conducted by the Department of Neurosurgery at Columbia University, research shows that administering antioxidants or free radical scavengers may lead to improved recovery for patients.
