Musculoskeletal imaging is a subspecialty of diagnostic radiology which involves ordering and interpreting medical images of bones, joints and associated…Read more
Consultation with the treating specialist (neurosurgeon or neurointerventionist) followed by referral to the neurointerventionist. The aim is early detection, as the likelihood of a good outcome from treatment is highest within the first 1-3 hours, and decreases dramatically thereafter. Most sites would initiate aggressive medical treatment before intervention – nimodipine, so called “Triple H” treatment, admission to the intensive care or HDU.
A CT scan is required to exclude other causes for neurological decline – mainly hydrocephalus or a re-bleed. It is preferable that the causative aneurysm has been secured (clipped or treated with endovascular occlusion) before treatment of vasospasm, but this is not seen as an absolute exclusion to treatment in critical circumstances.
Contrast allergy (severe).
Please see patient information section for detailed description of procedural risks.
Diagnosis of vasospasm is initially based on clinical suspicion, with subsequent imaging proof. Most commonly this has come from DSA, with CT scan to exclude other problems such as intracranial bleed, large stroke or hydrocephalus.
TCD (transcranial Doppler ultrasound) has been used as a regular screening tool, but has some limitations and is not universally accepted as a useful tool. MRI or MRA has not routinely been used to diagnose spasm, and is only occasionally used in this setting. CTA may have an expanding role, particularly when combined with new techniques assessing cerebral perfusion, but has yet to assume a widespread usage.
Images 1 & 2: before and after balloon angioplasty to the internal carotid and middle cerebral arteries
These images show frontal views of right internal carotid, middle cerebral and anterior cerebral arteries with vasospasm post aneurysm rupture (treated previously by surgical clipping). Patient had developed left sided arm and leg weakness. The second image shows the immediate result post balloon angioplasty to the internal carotid and middle cerebral arteries, with good result both on imaging, and clinically.
Last saved on 26 September 2016.
RANZCR® is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them.
RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
RANZCR® recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, RANZCR®, its Board, officers and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.