Predictors of Delayed Cerebral Ischaemia After Aneurysmal Subarachnoid Haemorrhage
DOI:
https://doi.org/10.5281/zenodo.22310380Keywords:
Delayed cerebral ischaemia, Subarachnoid haemorrhage, Vasospasm, Neurocritical care, Cerebral aneurysmAbstract
Background: Delayed cerebral ischaemia (DCI) remains a leading preventable cause of poor outcome after aneurysmal
subarachnoid haemorrhage. Objective: To synthesise the literature on clinical, radiographic and biomarker predictors of DCI, and on monitoring and prevention strategies. Methods: Narrative review of consensus statements, grading-scale studies, biomarker cohorts, monitoring-accuracy studies and randomised trials. Findings: Clinical grade (Hunt-Hess, WFNS) and radiographic clot burden (modified Fisher scale) are the strongest bedside predictors, combined in the VASOGRADE. Age, thick haemorrhage and poor neurological status predict DCI. Interleukin-6 and natriuretic peptides show the most consistent biomarker associations. Doppler and continuous EEG add monitoring value. Nimodipine remains the only intervention with proven benefit; other agents reduce vasospasm without improving function. Conclusions: DCI risk stratification should combine clinical grade, radiographic burden, and biomarker and multimodal
monitoring data to target surveillance and guide the still-limited preventive armamentarium.
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