subject: Cerebral Vasospasm Treatment in India: An Overview [print this page] Cerebral Vasospasm Treatment in India: An Overview
Treatment of Cerebral vasospasm in India is now being provided to the patients from all over the world with latest facilities and globally benchmarked healthcare services administered by surgeons and physicians trained in international medical practices. Indian hospitals are well equipped to provide a comprehensive range of treatments for vasospasm. Treatment of Cerebral vasospasm in India is provided at hospitals having a team of highly-trained doctors of international repute and research analysts working together to develop newer treatment approaches and using them for effective patient cure and care. With the use of advanced medical technology and newly invented techniques the recovery time after surgery is shortened.
What is Cerebral vasospasm and why does it Occur?
"Cerebral vasospasm" is a term that refers to physical narrowing of the central "lumen" of a brain blood vessel due to overcontraction of the vesselwall. Here, "cerebral" refers to the brain, while "vaso" refers to blood vessel and "spasm" refers to the vessel's "spastic" or "shut down" or "constricted" physical state. In the worst-case scenario, a vasospastic brain artery is so shut down it no longer permits blood flow as its central "lumen" no longer exists, a state that can be likened to a tightly clenched fist. Cerebral vasospasm generally occurs due to a ruptured brain aneurysm, or (very rarely) hemorrhages from another blood vessel abnormality such as an arteriovenous malformation (AVM). The common factor here is the abnormal presence of a substantial amount of blood on the outer ("subarachnoid" or "adventitial") surface of the blood vessel. This can particularly affect arteries at the base of the brain, i.e., around the Circle of Willis.In theory, blood from any cause of subarachnoid hemorrhage (SAH) can trigger vasospasm.It should be noted that cerebral vasospasm is also known to occur in patients who suffer SAH from traumatic brain injury (say, in motor vehicle or sporting accidents). Here, the amount of blood in the subarachnoid space may be less compared with patients experiencing aneurysmal rupture. Nonetheless, vasospasm may still occur, and its occurrence may negatively influence "outcome" in patients with significant traumatic SAH.
What are the symptoms of Cerebral vasospasm?
Thesymptoms (what a patient describes) andsigns (what a physician observes on physical examination) of Cerebral vasospasm are listed in the table below. They are listed in the order of least threatening to most threatening. Note that dysphasia refers to impaired language comprehension and communication (including speech) while hemiplegia refers to profound weakness down one side of the body. A classic picture of a "stroke" may involve one or more, and is usually a most severe event.
These symptoms and signs may "wax and wane" (i.e., come and go with different degrees of severity) for days. Their onset is usually at a time point at least 3 days after the bleed. They last up to 3 weeks.
How is Cerebral vasospasm treated?
At present, two very important aspects ofmedical managementof a patient at risk of, or suffering, from Cerebral vasospasm are: (1) commenceNimodipineearly; and (2) adhere where possible to the principles of hyperdynamic (HHH) therapy.
Nimodipineis a calcium channel blocker; it dilates or relaxes arteries by blocking the entry of calcium ions into vascular smooth muscle cells (Ca2+ entry normally stimulates their contraction). It may also be neuroprotective, i.e., offering direct protection to brain neurons.
HHHtherapy stands for hypervolemic-hypertensive-hemodilution therapy; basically this means keep the fluids (and therefore blood pressure or, more correctly, the mean arterial pressure) of a vasospasm patient up, and the concentration (or viscosity) of the patient's blood down. Together, this pattern of blood properties (i.e., this rheologic and hemodynamic profile) is associated with improved brain blood flow. Other methods used to emergently dilate or relax a vasospastic artery are based on using acathetereither to deliver a strong vasodilating agent (e.g.,papaverine) directly into the territory of the vasospastic artery in order to "pharmacologically dilate" it, or to physically wedge aballoon-tipcatheter in the vasospastic artery itself and use the balloon (expanded from the catheter-tip) to "mechanically dilate" the artery - a technique referred to asmechanical angioplasty. Papaverine therapy often works, but its effects are very short-lived. Mechanical angioplasty also works, but the artery can rupture during angioplasty, and normal arterial function is never really restored. Catheter-based techniques are reserved forsevere Vasospasm emergenciesand for optimal results require an experienced interventional neuroradiologist or endovascular neurosurgeon.
Surgically, perhaps the most helpful thing to do toprevent vasospasm is to clip the aneurysm early and remove as much of the subarachnoid blood products as possible (since these are known to trigger vasospasm). That is,thorough cisternal irrigationintr aoperatively. However, excessive mechanical manipulation of blood vessels intraoperatively can increase their risk of going into spasm.
Why India?
Treatment of Cerebral vasospasm in India is provided at internationally recognized hospitals using most advanced technology or service. India is the largest medical tourism hub, quality of care and easy travel makes it a popular overseas health care destination for people who are seeking comprehensive surgery abroad. Medical tourism in India works in collaboration with the best internationally renowned hospitals to make your treatment in India a successful and hassle free process. For more details on Treatment of Cerebral vasospasm in India, visit us at www.forerunnershealthcare.com or mail your queries at enquiry@forerunnershealthcare.com or call us at: +91-9371136499, +91- 9860755000 (International) / + 1-415-599-2537 (USA) / +44-20-8133-2571 (UK)
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