Vasospasm as the sole cause of cerebral ischemia: how strong is the evidence?

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✓ The authors review literature that challenges the view that vasospasm involving large arteries is the exclusive cause of delayed ischemic neurological deficits (DINDs) following subarachnoid hemorrhage. They discuss alternative mechanisms and review the evidence supporting a potential role for thromboembolism. They conclude that vasospasm and thromboembolism play interrelated and additive roles in the development of DINDs, and that this interaction provides opportunities for novel therapeutic approaches.

Abbreviations used in this paper:CBF = cerebral blood flow; DINDs = delayed ischemic neurological deficits; MR = magnetic resonance; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury; TCD = transcranial Doppler.

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Address reprint requests to: Sherman C. Stein, M.D., Department of Neurosurgery, University of Pennsylvania School of Medicine, 310 Spruce Street, Philadelphia, Pennsylvania 19106. email:

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