Pharmacologic management of subarachnoid hemorrhage.
Subarachnoid hemorrhage, following rupture of an intracranial aneurysm, affects about 25 000 people in the U.S. each year. Less than half the patients who survive until hospital admission have an overall favorable outcome. This high morbidity and mortality rate is a result of serious complications following the initial subarachnoid hemorrhage, the most significant of these being rebleeding and cerebral ischemia secondary to vasospasm. While surgical clipping of the aneurysm is the most definitive therapy, this procedure may be postponed for a week or two after the initial hemorrhage, depending on the patient's clinical condition. Pharmacological therapy is a critical part of the preoperative care of these patients and of the postoperative management of complications. This article discusses the syndromes of rebleeding and vasospasm and reviews the current pharmacologic therapy for each.
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001463:Barbiturates / Q000627:therapeutic use; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy*
D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D000779:Anesthetics, Local; D000933:Antifibrinolytic Agents; D001463:Barbiturates; D009125:Muscle Relaxants, Central; D010726:Phosphodiesterase Inhibitors