Vasospasm Management in SAH- NCS Question Title * 1. Specialty training: Neurology Neurosurgery Internal Medicine Anesthesiology Other (please specify) Question Title * 2. Sub Specialty: Critical Care Neurointerventional Stroke None Other (please specify) Question Title * 3. How do YOU define vasospasm in subarachnoid hemorrhage (SAH) patients in your practice? Click all that apply. Transcranial Doppler (TCD) velocities >120 cm/sec Transcranial Doppler (TCD) velocities >200 cm/sec Lindegaard Ratio >3 Lindegaard ratio >6 Clinical deterioration deemed secondary to vasospasm/delayed cerebral ischemia (DCI) Vasospasm found on angiography (CT or catheter) Perfusion imaging with evidence of ischemia or perfusion deficit. Other (please specify) Question Title * 4. In poor grade subarachnoid hemorrhages (Hunt Hess 4-5), which of the following do you rely on MOST for the diagnosis of vasospasm? Transcranial Doppler (TCD) Clinical Examination CT Angiography/CT Perfusion Catheter angiography EEG Other (please specify) Question Title * 5. How frequently do you perform transcranial dopplers on the following subarachnoid hemorrhage patients? Daily Few times per week If there is a neurological deterioration Never Hunt Hess Grade 1-3 Hunt Hess Grade 1-3 Daily Hunt Hess Grade 1-3 Few times per week Hunt Hess Grade 1-3 If there is a neurological deterioration Hunt Hess Grade 1-3 Never Hunt Hess Grade 4-5 Hunt Hess Grade 4-5 Daily Hunt Hess Grade 4-5 Few times per week Hunt Hess Grade 4-5 If there is a neurological deterioration Hunt Hess Grade 4-5 Never Question Title * 6. When do you perform CT angiography or CT perfusion imaging on the following subarachnoid hemorrhage patients? Screening Elevated TCD velocities Neurological deterioration due to vasospasm Refractory to OR on sustained hypertensive/hyperdynamic therapy Never Hunt Hess Grade 1-3 Hunt Hess Grade 1-3 Screening Hunt Hess Grade 1-3 Elevated TCD velocities Hunt Hess Grade 1-3 Neurological deterioration due to vasospasm Hunt Hess Grade 1-3 Refractory to OR on sustained hypertensive/hyperdynamic therapy Hunt Hess Grade 1-3 Never Hunt Hess Grade 4-5 Hunt Hess Grade 4-5 Screening Hunt Hess Grade 4-5 Elevated TCD velocities Hunt Hess Grade 4-5 Neurological deterioration due to vasospasm Hunt Hess Grade 4-5 Refractory to OR on sustained hypertensive/hyperdynamic therapy Hunt Hess Grade 4-5 Never Question Title * 7. When do you perform diagnostic catheter angiography on the following subarachnoid hemorrhage patients? Screening Elevated TCD velocities Neurological deterioration due to vasospasm Refractory to OR on sustained hypertensive/hyperdynamic therapy Never Hunt Hess Grade 1-3 Hunt Hess Grade 1-3 Screening Hunt Hess Grade 1-3 Elevated TCD velocities Hunt Hess Grade 1-3 Neurological deterioration due to vasospasm Hunt Hess Grade 1-3 Refractory to OR on sustained hypertensive/hyperdynamic therapy Hunt Hess Grade 1-3 Never Hunt Hess Grade 4-5 Hunt Hess Grade 4-5 Screening Hunt Hess Grade 4-5 Elevated TCD velocities Hunt Hess Grade 4-5 Neurological deterioration due to vasospasm Hunt Hess Grade 4-5 Refractory to OR on sustained hypertensive/hyperdynamic therapy Hunt Hess Grade 4-5 Never Question Title * 8. When do you utilize EEG on the following subarachnoid hemorrhage patients? Screening Elevated TCD velocities Neurologic deterioration due to vasospasm Refractory to OR on hypertensive/hyperdynamic therapy Never Hunt Hess Grade 1-3 Hunt Hess Grade 1-3 Screening Hunt Hess Grade 1-3 Elevated TCD velocities Hunt Hess Grade 1-3 Neurologic deterioration due to vasospasm Hunt Hess Grade 1-3 Refractory to OR on hypertensive/hyperdynamic therapy Hunt Hess Grade 1-3 Never Hunt Hess Grade 4-5 Hunt Hess Grade 4-5 Screening Hunt Hess Grade 4-5 Elevated TCD velocities Hunt Hess Grade 4-5 Neurologic deterioration due to vasospasm Hunt Hess Grade 4-5 Refractory to OR on hypertensive/hyperdynamic therapy Hunt Hess Grade 4-5 Never Question Title * 9. Which of the following do you most frequently use in the treatment of GOOD GRADE (Hunt Hess Grade 1-3) subarachnoid hemorrhage patients who are ASYMPTOMATIC? Normal TCD Vasospasm on TCD Vasospasm on angiography Perfusion deficit on CT Perfusion None None Normal TCD None Vasospasm on TCD None Vasospasm on angiography None Perfusion deficit on CT Perfusion Nimodipine Nimodipine Normal TCD Nimodipine Vasospasm on TCD Nimodipine Vasospasm on angiography Nimodipine Perfusion deficit on CT Perfusion Hypervolemia Hypervolemia Normal TCD Hypervolemia Vasospasm on TCD Hypervolemia Vasospasm on angiography Hypervolemia Perfusion deficit on CT Perfusion Hemodilution Hemodilution Normal TCD Hemodilution Vasospasm on TCD Hemodilution Vasospasm on angiography Hemodilution Perfusion deficit on CT Perfusion Induced hypertension with catecholamines Induced hypertension with catecholamines Normal TCD Induced hypertension with catecholamines Vasospasm on TCD Induced hypertension with catecholamines Vasospasm on angiography Induced hypertension with catecholamines Perfusion deficit on CT Perfusion Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Normal TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on angiography Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Perfusion deficit on CT Perfusion Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Normal TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on angiography Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Perfusion deficit on CT Perfusion Question Title * 10. Which of the following do you most frequently use in the treatment of GOOD GRADE (Hunt Hess Grade 1-3) subarachnoid hemorrhage patients who are SYMPTOMATIC? Normal TCD Vasospasm on TCD Vasospasm on angiography Perfusion deficit on CT Perfusion None None Normal TCD None Vasospasm on TCD None Vasospasm on angiography None Perfusion deficit on CT Perfusion Nimodipine Nimodipine Normal TCD Nimodipine Vasospasm on TCD Nimodipine Vasospasm on angiography Nimodipine Perfusion deficit on CT Perfusion Hypervolemia Hypervolemia Normal TCD Hypervolemia Vasospasm on TCD Hypervolemia Vasospasm on angiography Hypervolemia Perfusion deficit on CT Perfusion Hemodilution Hemodilution Normal TCD Hemodilution Vasospasm on TCD Hemodilution Vasospasm on angiography Hemodilution Perfusion deficit on CT Perfusion Induced hypertension with catecholamines Induced hypertension with catecholamines Normal TCD Induced hypertension with catecholamines Vasospasm on TCD Induced hypertension with catecholamines Vasospasm on angiography Induced hypertension with catecholamines Perfusion deficit on CT Perfusion Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Normal TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on angiography Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Perfusion deficit on CT Perfusion Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Normal TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on angiography Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Perfusion deficit on CT Perfusion Question Title * 11. Which of the following do you most frequently use in the treatment of POOR GRADE (Hunt Hess Grade 4-5) subarachnoid hemorrhage patients who are ASYMPTOMATIC? Normal TCD Vasospasm on TCD Vasospasm on angiography Perfusion deficit on CT Perfusion None None Normal TCD None Vasospasm on TCD None Vasospasm on angiography None Perfusion deficit on CT Perfusion Nimodipine Nimodipine Normal TCD Nimodipine Vasospasm on TCD Nimodipine Vasospasm on angiography Nimodipine Perfusion deficit on CT Perfusion Hypervolemia Hypervolemia Normal TCD Hypervolemia Vasospasm on TCD Hypervolemia Vasospasm on angiography Hypervolemia Perfusion deficit on CT Perfusion Hemodilution Hemodilution Normal TCD Hemodilution Vasospasm on TCD Hemodilution Vasospasm on angiography Hemodilution Perfusion deficit on CT Perfusion Induced hypertension with catecholamines Induced hypertension with catecholamines Normal TCD Induced hypertension with catecholamines Vasospasm on TCD Induced hypertension with catecholamines Vasospasm on angiography Induced hypertension with catecholamines Perfusion deficit on CT Perfusion Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Normal TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on angiography Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Perfusion deficit on CT Perfusion Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Normal TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on angiography Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Perfusion deficit on CT Perfusion Question Title * 12. Which of the following do you most frequently use in the treatment of POOR GRADE (Hunt Hess Grade 4-5) subarachnoid hemorrhage patients who are SYMPTOMATIC? Normal TCD Vasospasm on TCD Vasospasm on angiography Perfusion deficit on CT Perfusion None None Normal TCD None Vasospasm on TCD None Vasospasm on angiography None Perfusion deficit on CT Perfusion Nimodipine Nimodipine Normal TCD Nimodipine Vasospasm on TCD Nimodipine Vasospasm on angiography Nimodipine Perfusion deficit on CT Perfusion Hypervolemia Hypervolemia Normal TCD Hypervolemia Vasospasm on TCD Hypervolemia Vasospasm on angiography Hypervolemia Perfusion deficit on CT Perfusion Hemodilution Hemodilution Normal TCD Hemodilution Vasospasm on TCD Hemodilution Vasospasm on angiography Hemodilution Perfusion deficit on CT Perfusion Induced hypertension with catecholamines Induced hypertension with catecholamines Normal TCD Induced hypertension with catecholamines Vasospasm on TCD Induced hypertension with catecholamines Vasospasm on angiography Induced hypertension with catecholamines Perfusion deficit on CT Perfusion Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Normal TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on TCD Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Vasospasm on angiography Endovascular therapy (Intra-arterial vasodilators/angioplasty/stent) Perfusion deficit on CT Perfusion Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Normal TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on TCD Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Vasospasm on angiography Systemic inotropic support (Milrinone/Dobutamine/Intra-aortic balloon pump) Perfusion deficit on CT Perfusion Question Title * 13. How long do you treat vasospasm? Until clinical symptoms resolve. Until TCD velocities normalize. Until period of vasospasm risk is over (14 days). Until angiography of vessels normalize. Other (please specify) Done