Controversies in the management of aneurysmal subarachnoid hemorrhage.
BACKGROUND
The care of patients with aneurysmal subarachnoid hemorrhage has evolved significantly with the advent of new diagnostic and therapeutic modalities. Although it is believed that these advances have contributed to improved outcomes, considerable uncertainty persists regarding key areas of management.


OBJECTIVE
To review selected controversies in the management of aneurysmal subarachnoid hemorrhage, with a special emphasis on endovascular vs. surgical techniques for securing aneurysms, the diagnosis and therapy of cerebral vasospasm, neuroprotection, antithrombotic and anticonvulsant agents, cerebral salt wasting, and myocardial dysfunction, and to suggest venues for further clinical investigation.


METHODS
Search of MEDLINE and Cochrane databases and manual review of article bibliographies.


CONCLUSIONS
Many aspects of care in patients with aneurysmal subarachnoid hemorrhage remain highly controversial and warrant further resolution with hypothesis-driven clinical or translational research. It is anticipated that the rigorous evaluation and implementation of such data will provide a basis for improvements in short- and long-term outcomes.
Naval
Neeraj S
NS
Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Stevens
Robert D
RD
Mirski
Marek A
MA
Bhardwaj
Anish
A
D002545:Brain Ischemia / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D003422:Critical Care; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000628:therapy
D005343:Fibrinolytic Agents