title: Mechanisms, treatment and prevention of cellular injury and death from delayed events after aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Subarachnoid hemorrhage (SAH) patients often develop brain injury as a result of a number of delayed complications, resulting in significant morbidity and mortality. Many of these complications arise due to delayed cerebral ischemia, which occurs secondary to the hemorrhage.
  
  
  METHODS
  The mechanisms of the delayed injury are reviewed, including angiographic vasospasm, cortical spreading ischemia, small arteriolar constriction, microthromboemboli, free radical injury and inflammation. Some current and prospective therapies for SAH are discussed, in the context of these complications. Statins have been particularly promising in experimental studies.
  
  
  CONCLUSIONS
  Multiple mechanisms are involved in the pathogenesis of the delayed insult after SAH. New drugs may need to target multiple pathways to injury. Trials aiming to treat complications after SAH could benefit from taking into account the multifactorial pathogenesis of delayed insults.
authors.affiliation: University of Toronto, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Division of Neurosurgery, Department of Surgery , Toronto, Ontario, M5B 1W8 , Canada.
authors.forename: Hoyee
authors.initials: H
authors.lastname: Wan
authors.forename: Bader Murshed
authors.initials: BM
authors.lastname: AlHarbi
authors.forename: Robert Loughlin
authors.initials: RL
authors.lastname: Macdonald
mesh_terms: D000818:Animals; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D015195:Drug Design; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D002532:Intracranial Aneurysm / Q000150:complications* / Q000473:pathology / Q000628:therapy; D058990:Molecular Targeted Therapy; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000473:pathology / Q000628:therapy; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors