Monitoring of cerebral hemodynamics and oxygenation to detect delayed ischemic neurological deficit after aneurysmal subarachnoid hemorrhage.

One of the major goals in the treatment of patients with aneurysmal subarachnoid hemorrhage (aSAH) is early detection and treatment of delayed ischemic neurologic deficits (DINDs) to prevent cerebral infarction and thus poor outcome or even death. The complex changes of cerebral metabolism, hemodynamics, and oxygenation after SAH are underestimated if they are considered exclusively based on angiographic cerebral vasospasm (CVS). The discrepancies on one hand may arise from the heterogeneous and complex pathophysiology of DINDs. On the other hand, the occurrence of DINDs may depend on the relationship between local cerebral oxygen delivery and demand, which can only be determined if cerebral blood flow (CBF) and the cerebral metabolic rate of oxygen (CMRO(2)) can be measured. We briefly review the most relevant methods for monitoring cerebral hemodynamics and oxygenation and discuss the limitations associated with early diagnosis of DINDs in patients with severe aSAH not amenable for clinical neurological examination.