Vasospasm

A vasospasm is the narrowing of the arteries caused by a persistent contraction of the blood vessels, which is known as vasoconstriction. This narrowing can reduce blood flow.

Vasospasms can affect any area of the body including the brain (cerebral vasospasm) and the coronary artery (coronary artery vasospasm).

When the vasospasm occurs in the brain, it is often due to a subarachnoid hemorrhage after a cerebral aneurysm has ruptured.

Symptoms

Symptoms of a vasospasm can vary depending on the area of the body affected. When the condition occurs in the brain symptoms may include:

  • Fever
  • Neck stiffness
  • Confusion
  • Difficulty with speaking
  • Weakness on one side of the body

Patients who have experienced a cerebral vasospasm often also have stroke-like symptoms:

  • Numbness or weakness of the face, arm or leg, especially on one side of the body
  • Confusion
  • Trouble speaking
  • Trouble seeing in one or both eyes
  • Trouble walking
  • Dizziness, loss of balance or coordination
  • Severe headache with no known cause

When the condition occurs in the arms or legs, symptoms include:

  • Sharp pain, often described as burning or stinging, at the affected area
  • Finger or toe turning purple or blue

When a vasospasm develops in the coronary artery, the main symptom is chest pain often described as constricting, crushing, pressure, squeezing or tightness.


Causes and Risk Factors

Patients who have experienced hemorrhagic stroke are at an increased risk of developing a cerebral vasospasm. Patients with atherosclerosis, a condition where fatty deposits build up and harden on the inside of the arteries, are at an increased risk of developing coronary artery vasospasms.

Patients with Rynaud's Phenomenon are also at an increased risk of developing vasospasms in the toes or fingers.

Diagnosis

Diagnosis of a vasospasm usually begins with a physical exam and a review of the patient’s medical history and symptoms. For vasospasms that are minor, this is often adequate to diagnose the condition. For more severe conditions other diagnostic tools will be used.

Imaging tests, including magnetic resonance imaging (MRI) and computed tomography (CT) angiography, are used to diagnosed the condition and observe the area affected by the reduced blood flow.

Other tests look exclusively at the blood vessels within the body. An angiogram may be used to view the arteries. A transcranial Doppler (TCD) ultrasound is used to measure the blood that is flowing through the arteries at the base of the brain.

If the vasospasm is in the coronary artery an electrocardiogram (ECG) or an echocardiogram may also be used to diagnose the condition.

Treatments

Treatment of vasospasms depends on the severity of the condition and the area of the body it is affecting.

For patients who have experienced a mild form of the condition affecting one of the body's extremities, such as a finger or toe, treatment will focus on preventing episodes of vascular constriction. This may include avoiding cold air, vibration and emotional stress. Lifestyle changes to improve circulation, such as stopping smoking, also will be recommended.

For more severe cases affecting the coronary artery, treatment will focus on minimizing chest pain and preventing a heart attack. Both of these goals can be achieved through medication such as nitroglycerin, long-acting nitrates, calcium channel-blockers or beta-blockers.

Treatment for vasospasms caused by bleeding inside the skull will vary depending on what caused it, where it is and how large it is. Treatment will usually focus on treating the bleeding first, which may involve interventional radiology or neurosurgery to treat abnormal or leaky blood vessels. The knowledgeable and highly trained staff at Cedars-Sinai's Department of Neurosurgery and the Neurovascular Center will work with each patient to determine the best treatment option.

For patients who have experienced a stroke, the Stroke Program at Cedars-Sinai provides a multidisciplinary treatment approach focused on three areas: stroke prevention, immediate stroke treatment and post-stroke rehabilitation.