The faculty and course director, Gregory Kapinos, MD, MS, will review the recent data revealing that multimodal neuroimaging can help redefine what constitutes delayed cerebral ischemia (DCI) and vasospasm after subarachnoid hemorrhage (SAH).
New techniques in diffusion, perfusion, permeability, flow heterogeneity, susceptibility and spectroscopic imaging as well as CT/MR angiography and vasoreativity-testing by transcranial dopplers will be reviewed.
The faculty will cover in 80 minutes current literature and ongoing research addressing the need to better delineate subcategories for DCI/vasospasm and propose a novel classification of secondary injury after SAH, based mainly on advanced neuroimaging. The remaining 10 minutes will be used for 1 break and discussions on clinical cases and research projects suggested by the audience.
7:00 - 7:15 am Terminological variance for delayed cerebral ischemia (DCI) and vasospasm after subarachnoid hemorrhage (SAH)
7:15 - 7:30 am Input of advanced multimodal neuroimaging in redefining DCI
7:30 - 8:00am Prediction and early detection of DCI by CT perfusion
8:00 - 8:05am Break
8:05 - 8:25 am Beyond perfusion deficits, measuring oxidative disarray by neuroimaging and intracranial monitoring
8:25 - 8:30 am Questions
Upon completion of the course, attending healthcare providers will:
1) Know the broad categories and subcategories of DCI and cerebral inflammatory insults after SAH;
2) Become familiar with interpreting MR and CT imaging in SAH with its specific values in terms of
a- diagnostics (defining DCI and other insults like cerebral edema and other inflammatory insults),
b- early prediction of vasospasm/DCI (based on CT, TCDs with and without vasoreactivity testing and perfusion studies),
c- implications in terms of adjusting our daily monitoring for DCI/vasospasm (when to increase frequency of neurological examinations and TCDs, when to order a CTP or MRI or conventional cerebral angiography),
d- nosology for vasospasm/DCI (understanding DCI to tailor treatment and monitoring and to better categorize patients in clinical trials and registries),
e- prognostication for DCI/vasospasm, as well as for functional outcome/survival (based on clinical, imaging, sonographic as well as intracranial and electroencephalographic daily monitoring in the ICU),
f- implications in terms of DCI treatment modalities (how to treat delayed neurological deterioration vs pressure-dependent neurological signs vs sonographic vasospasm vs angiographic vasospasm vs ischemic lesions on DWI vs hypoperfusion on CTP);
This course is intended for all providers caring for SAH patients:
1) neurologists consulting in ERs and ICUs for the care of SAH patients
2) neurosurgeons
3) intensivists and urgentists
4) neuroradiologists and neuroimagers
5) residents and fellows in neurology, neurosurgery, anesthesia, emergency medicine
6) critical care nurses
7) physician-assistants and nurse practitioners in neurosciences and critical care.
Synopsis:
From its original description to modern contentions on the different definitions, cerebral vasospasm after SAH has evolved into delayed cerebral ischemia, mostly along the development of advanced neuroimaging. It is now time to propose a rubrical classification of all the subtypes of secondary decline after SAH, in light of the clinical, sonographic, angiographic, diffusive, perfusive, vasoreactive, spectroscopic, nuclear and microdialytic explorations reported in the results of the recent cohort studies. The audience will learn, through this 80-minute single lecture, that conventional angiography is not the gold-standard any longer and see how modern neuroimaging and clinical reasoning can delineate new categories for these delayed ischemic and inflammatory injuries after SAH.