Cerebral vasospasm after aneurysmal subarachnoid hemorrhage: an overview of pharmacologic management.
Cerebral vasospasm remains one of the leading causes of mortality in patients who experience a subarachnoid hemorrhage but survive the initial 24 hours. Vasospasm generally occurs 3-4 days after the initial subarachnoid hemorrhage and peaks at 5-7 days. The pathophysiology of vasospasm is poorly understood, which directly contributes to the inconsistency of management and creates a formidable challenge in clinical practice. Traditionally, hemodilution, hypervolemia, and induced hypertension (so-called triple H therapy); calcium channel blockers; and endovascular therapy have been used as either prophylactic therapy or treatment. However, management of vasospasm varies among physicians and institutions mainly because of a lack of large clinical trials and inconsistent results. Practice has been based primarily on case reports and the preference of each practitioner. Several experimental therapies have been explored; however, large, prospective, randomized controlled trials are needed to elucidate the role of these therapies.
Liu-Deryke
Xi
X
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan 48201, USA.
Rhoney
Denise H
DH
D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*