Image Guided Lumbar Epidural Corticosteroid Injection
What are the generally accepted indications for an image guided lumbar epidural corticosteroid injection? Short term (i.e. up to 3…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 (consumer) 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.
Page last modified on 22/8/2017.
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