Brief Answer:
Please find details below

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations bwloe.

1. The CT brain angiography shows that the distal two thirds of basilar artery and right superior cerebellar artery have gone in to vasospasm with non visualization of right anterior and left posterior inferior cerebellar arteries.

2. Vasospasm happens when the smooth muscle in the wall of the concerned blood vessels go in to a state of spasm which is a prolonged state of contraction. This can affect the amount of blood flow through these vessels. Vasospasm commonly appears secondary to rupture of an artery and the symptoms are seen 3 to 4 days after the rupture and are most severe 7 to 10 days following the rupture.

3. Treatment of vasospasm involves reversal of the factors causing the prolonged smooth muscle contraction in the wall of arteries.

(i) Cerebroselective calcium channel blocker nimodipine is one of the medicines used for this purpose. Nimatop is already being given for this purpose.
(ii) Hypervolemic, hypertensive therapy is used to elevate the cerebral perfusion pressure in the brain.
(iii) Tirilazad is being used in clinical trials and is a nonglucocorticoid, 21-aminosteroid that inhibits lipid peroxidation which is one of the possible causes of vasospasm.

4. Preventing a recurrence of bleeding and vasospasm is by identifying the cause of bleed and treating the primary condition. Blood pressure control is the key to prevent another stroke episode and bleeding.

5. It is important to monitor your sister closely for a week or two following the first episode of bleeding. The slight elevation in blood sugar is not a serious concern. Blood pressure regulation in the brain is the most important right now and I think the doctors are trying their best to maintain it at normal levels.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please find details below

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. It is important to note that there is mild vasospasm in basilar artery in the CT scan report.

2. When we assess vasospasm, mild refers to less than 25 percent and this has a better outcome that moderate or severe vasospasm.

3. In mild vasospasm of basilar artery, the outcome is favorable in approximately 64 percent of patients at the end of three months in one study. If there is severe vasospasm of basilar artery then the outcome is favorable in 22 percent.

4. The resolution of vasospasm might take a longer time and for this reason, the outcome at 3 months is important and uses as a bench mark.

5. If the doctor has told that she requires rest for a month then they expect her to recover completely in 3 months time. The next three months are important for her and that is why someone should be around should there be any emergency when she is a t home.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Vasospasm of brain vessels is not a primary congenital condition

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Vasospasm of blood vessels in the brain is never primary congenital condition. Vasospasm is a state of contraction of walls of blood vessels. This is a reaction that is observed as a sudden contraction of the smooth muscles.

2. If the vessels are narrow by birth and congenital then it is called as hypoplastic arteries.

3. However, brain abnormalities which are congenital in origin might cause subarachnoid hemorrhage leading to vasospasm.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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