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Review
. 2022 May;80(5 Suppl 1):80-87.
doi: 10.1590/0004-282X-ANP-2022-S101.

Updates on aneurysmal subarachnoid hemorrhage: is there anything really new?

Thire Baggio Machado Marazzi  1 , Pedro Vitale Mendes  2
Affiliations
Review

Updates on aneurysmal subarachnoid hemorrhage: is there anything really new?

Thire Baggio Machado Marazzi et al. Arq Neuropsiquiatr. 2022 May.

Abstract
in English, Portuguese

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe disease, with systemic involvement and complex diagnosis and treatment. Since the current guidelines were published by the AHA/ASA, Neurocritical Care Society and the European Stroke Organization in 2012-2013,there has been an evolution in the comprehension of SAH-associated brain injury and its multiple underlying mechanisms. As a result, several clinical and translational trials were developed or are underway. Objective: The aim of this article is to review some updates in the diagnosis and treatment of neurological complications of SAH. Methods: A review of PubMed (May, 2010 to February, 2022) was performed. Data was summarized. Results: Content of five meta-analyses, nine review articles and 23 new clinical trials, including pilots, were summarized. Conclusions:Advances in the comprehension of pathophysiology and improvements in critical care have been reflected in the reduction of mortality in SAH. However, despite the number of publications, the only treatments shown to be effective in adequate, well-controlled clinical trials are nimodipine and repair of the ruptured aneurysm. Thus, doubts about the optimal management of SAH still persist.

Antecedentes: Hemorragia subaracnóide aneurismática (HSAa) é uma doença grave, com envolvimento sistêmico, complexo diagnóstico e tratamento. Desde a publicação dos atuais protocolos de conduta pela AHA/ASA, Neurocritical Care Society e European Stroke Organization de 2012-2013, houve evolução na compreensão da lesão cerebral associada à HSA e seus múltiplos mecanismos subjacentes. Como resultado, muitos trabalhos clínicos e translacionais foram desenvolvidos ou estão em andamento.

Objetivos: O objetivo deste artigo é revisar algumas das atualizações no diagnóstico e tratamento de complicações neurológicas de HSA.

Métodos: Revisão de Pubmed (Maio de 2010 a Fevereiro de 2022) foi realizada. Dados foram sintetizados.

Resultados: O conteúdo de 5 metanálises, 9 artigos de revisão e 23 novos estudos clínicos, incluindo pilotos, foram sumarizados.

Conclusões: Avanços na compreensão da fisiopatologia e melhorias no cuidado crítico têm se refletido na redução da mortalidade em HSA. Entretanto, apesar do volume de publicações, os únicos tratamentos que se mostraram efetivos com testes clínicos bem controlados são o uso de nimodipino e o tratamento dos aneurisma rotos. Assim, dúvidas acerca do manejo ideal em HSA ainda persistem.

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Conflict of interest statement

Conflict of interest: There is no conflict of interest to declare

Figures

Figure 1.
Figure 1.. Milrinone use Montreal Protocol.
See this image and copyright information in PMC

References

    1. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):P355–P369. doi: 10.1016/S1474-4422(09)70025-0. - DOI - PubMed
    1. Ingall T, Asplund K, Mähönen M, Bonita R. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke. 2000;31(5):1054–1061. doi: 10.1161/01.STR.31.5.1054. - DOI - PubMed
    1. Connolly ES, Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43(6):1711–1737. doi: 10.1161/STR.0b013e3182587839. - DOI - PubMed
    1. Rouanet C, Silva GS. Aneurysmal subarachnoid hemorrhage: current concepts and updates. Arq Neuropsiquiatr. 2019;77(11):806–814. doi: 10.1590/0004-282X20190112. - DOI - PubMed
    1. Lovelock CE, Rinkel GJE, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: Population-based study and systematic review. Neurology. 2010;74(19):1494–1501. doi: 10.1212/WNL.0b013e3181dd42b3. - DOI - PMC - PubMed

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