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Review
. 2025 Feb;43(1):107-126.
doi: 10.1016/j.ncl.2024.07.006. Epub 2024 Oct 15.

High-Grade Subarachnoid Hemorrhage - Beyond Guidelines

Sarah Wyckoff  1 , Sherry Hsiang-Yi Chou  2
Affiliations
Review

High-Grade Subarachnoid Hemorrhage - Beyond Guidelines

Sarah Wyckoff et al. Neurol Clin. 2025 Feb.

Abstract

Subarachnnoid hemorrhage (SAH) present in a spectrum of clinical severity, from alert with a headache to comatose. High-grade SAH has higher mortality and risk for severe complications including acute respiratory distress syndrome (ARDS) and delayed cerebral ischemia (DCI). Existing treatment approaches for ARDS in SAH require special consideration because of potential impact on intracranial pressure and cerebral perfusion. DCI is a major cause of SAH morbidity and is often discordant with angiographic vasospasm. Current treatment approaches for DCI and vasospasm require further investigation to determine efficacy and risk/benefit. Nimodipine remains the only therapeutic that is proven to improve SAH outcome.

Keywords: ARDS; Delayed cerebral ischemia; Intracranial hypertension; Practice guidance; Subarachnoid hemorrhage; Vasospasm.

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Conflict of interest statement

Disclosure S. H-Y Chou reports compensation from CSL-Behring for consultant services; service as Board of Directors member for Neurocritical Care Society; compensation from Acasti Pharma for consultant services; research grants from the Neurocritical Care Society, United States; employment by Northwestern Medicine; employment by Northwestern University; research grants from National Institute of Neurological Disorders and Stroke, United States (R21-NS113037); and compensation from BioVie for consultant services. S. H-Y Chou serves on the editorial board for Stroke and serves as associate editor for Translational Stroke Research.

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