Spontaneous subarachnoid hemorrhage and glucose management

Although metabolic abnormalities have been linked with poor outcome after subarachnoid hemorrhage, there are limited data addressing the impact of glycemic control or benefits of glucose management after aneurysmal subarachnoid hemorrhage. A systematic literature search was conducted of English-language articles describing original research on glycemic control in patients with subarachnoid hemorrhage. Case reports and case series were excluded. A total of 22 publications were selected for this review. Among the 17 studies investigating glucose as an outcome predictor, glucose levels during hospitalization were more likely to predict outcome than admission glucose. In general, hyperglycemia was linked to worse outcome. While insulin therapy in subarachnoid hemorrhage patients was shown to effectively control plasma glucose levels, plasma glucose control was not necessarily reflective of cerebral glucose such that very tight glucose control may lead to neuroglycopenia. Furthermore, tight glycemic control was associated with an increased risk for hypoglycemia which was linked to worse outcome.