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Review
. 2021 Jul 26;21(9):50.
doi: 10.1007/s11910-021-01136-9.

Aneurysmal Subarachnoid Hemorrhage: Review of the Pathophysiology and Management Strategies

Marcey L Osgood  1
Affiliations
Review

Aneurysmal Subarachnoid Hemorrhage: Review of the Pathophysiology and Management Strategies

Marcey L Osgood. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: Aneurysmal subarachnoid hemorrhage remains a devastating disease process despite medical advances made over the past 3 decades. Much of the focus was on prevention and treatment of vasospasm to reduce delayed cerebral ischemia and improve outcome. In recent years, there has been a shift of focus onto early brain injury as the precursor to delayed cerebral ischemia. This review will focus on the most recent data surrounding the pathophysiology of aneurysmal subarachnoid hemorrhage and current management strategies.

Recent findings: There is a paucity of successful trials in the management of subarachnoid hemorrhage likely related to the targeting of vasospasm. Pathophysiological changes occurring at the time of aneurysmal rupture lead to early brain injury including cerebral edema, inflammation, and spreading depolarization. These events result in microvascular collapse, vasospasm, and ultimately delayed cerebral ischemia. Management of aneurysmal subarachnoid hemorrhage has remained the same over the past few decades. No recent trials have resulted in new treatments. However, our understanding of the pathophysiology is rapidly expanding and will advise future therapeutic targets.

Keywords: Delayed cerebral ischemia; Early brain injury; Spreading depolarization; Subarachnoid hemorrhage; Vasospasm.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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