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When clinical deterioration caused by delayed cerebral ischemia occurs in patients with aneurysmal subarachnoid hemorrhage, Japanese neurosurgeons often call it symptomatic cerebral vasospasm. However, it is well known that many factors contribute to the development of ischemic symptoms or cerebral infarction in patients with angiographic vasospasm, while delayed cerebral ischemia that is not associated with angiographic vasospasm can occur. Thus, the term ‘symptomatic cerebral vasospasm’ is no longer used in the guidelines published by the American Stroke Association since 2012. In a clinical setting, as accurate, reliable, and sensitive tests are not available to measure delayed cerebral ischemia yet, the guidelines recommend that delayed cerebral ischemia be assessed by the combination of the presence of clinical neurological deterioration and morphologically defined vasospasm, after excluding any identical cause on clinical assessment, computed tomography, magnetic resonance imaging or laboratory studies. To improve subarachnoid hemorrhage patient outcomes, we need to better understand the pathophysiology of delayed cerebral ischemia and to develop novel therapies to augment modern standard treatments. (Received August 21, 2017;accepted September 11, 2017)

Cerebral Vasospasm and Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage : Current Concepts, Treatment and Future Directions