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Published on: June 18, 2021
"Subarachnoid Hemorrhage: Review of Latest Management Approaches"
Camila Narvaez-Caicedo1, Thomas P Bleck2
1Division of Neurocritical Care, The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, US. camilanarvaezca@gmail.com.
Purpose Of Review:
This review summarizes recent advances in the management of aneurysmal subarachnoid hemorrhage (aSAH) since the 2023 Neurocritical Care Society and American Heart Association/American Stroke Association guidelines, with a focus on strategies targeting secondary brain injury and delayed cerebral ischemia (DCI).
Recent Findings:
Recent studies evaluated early lumbar cerebrospinal fluid drainage for clearance of subarachnoid blood, endothelin receptor antagonism and localized nicardipine delivery for vasospasm prevention, and liberal red blood cell transfusion strategies to optimize cerebral oxygen delivery. Advances in multimodal neuromonitoring may facilitate earlier detection and treatment of secondary brain injury. Artificial intelligence models integrating clinical and imaging data have demonstrated promising accuracy for early outcome prediction. New evidence supports an approach to aSAH management extending beyond prevention and treatment of large-vessel vasospasm. Although previous strategies have demonstrated better physiological outcomes, uncertainty remains in their effects on functional outcomes. Future research should focus on targeting the multiple processes underlying secondary brain injury.
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