Abstract：
Traumatic subarachnoid hemorrhage (tSAH) is frequently comorbid with traumatic brain injury (TBI) and may induce secondary injury through vascular changes such as vasospasm and subsequent delayed cerebral ischemia (DCI). While aneurysmal SAH is well studied regarding vasospasm and DCI, less is known regarding tSAH and the prevalence of vasospasm and DCI, the consequences of vasospasm in this setting, when treatment is indicated, and which management strategies should be implemented. In this article, a systematic review of the literature that was conducted for cases of symptomatic vasospasm in patients with TBI is reported, association with tSAH is reported, risk factors for vasospasm and DCI are summarized, and commonalities in diagnosis and management are discussed. Clinical characteristics and treatment outcomes of 38 cases across 20 studies were identified in which patients with TBI with vasospasm underwent medical or endovascular management. Of the patients with data available for each category, the average age was 48.7 ± 20.3 years (n = 31), the Glasgow Coma Scale score at presentation was 10.6 ± 4.5 (n = 35), and 100% had tSAH (n = 29). Symptomatic vasospasm indicative of DCI was diagnosed on average at postinjury day 8.4 ± 3.0 days (n = 30). Of the patients, 56.6% (n = 30) had a new ischemic change associated with vasospasm confirming DCI. Treatment strategies are discussed, with 11 of 12 endovascularly treated and 19 of 26 medically treated patients surviving to discharge. tSAH is associated with vasospasm and DCI in moderate and severe TBI, and patients with clinical and radiographic evidence of symptomatic vasospasm and subsequent DCI may benefit from endovascular or medical management strategies.
摘要：
外伤性蛛网膜下腔出血(tSAH)常与创伤性脑损伤(TBI)合并,并可能通过血管痉挛和随后的迟发性脑缺血（DCI）等血管变化引起继发性损伤。虽然动脉瘤性SAH在血管痉挛和DCI方面得到了充分的研究，但关于tSAH和血管痉挛和DCI的患病率以及在这种情况下血管痉挛的后果知之甚少。当需要治疗时，以及应该实施哪些管理策略。在这里，对TBI患者症状性血管痉挛的病例进行了系统的文献回顾，据报道与tSAH有关联，总结了血管痉挛和DCI的危险因素，并讨论了诊断和管理中的共性。在20项研究中，确定了38例患者的临床特征和治疗结果，其中TBI合并血管痉挛的患者接受了医学或血管内治疗。在每个类别都有可用数据的案例中，平均年龄为48.7±20.3岁(n=31)，GCS在演示文稿10.6±4.5（n=35），100%患有tSAH(n=29)。在损伤后第8.4±3.0天(n=30)平均诊断为指示DCI的症状性血管痉挛。56.6％的病例（n=30）出现了与血管痉挛相关的新的缺血性变化，证实了DCI。讨论了治疗策略，12例接受血管内治疗的患者中有11例，26例接受药物治疗的患者中有19例存活出院。总之,在中度和重度TBI中，tSAH与血管痉挛和DCI相关，具有症状性血管痉挛和随后发生DCI的临床和影像学证据的患者可能会受益于血管内或医疗管理策略。
