Treatment of poor‒grade subarachnoid hemorrhage

Abstract

The outcome of patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) remains poor. In addition to early aneurysm treatment, immediate control of elevated intracranial pressure associated with early brain injury (EBI), treatment of systemic complications, and management of delayed cerebral ischemia (DCI) are required to improve patient outcome. The main causes of poor outcome are EBI and DCI. Treatment of DCI is challenging; there is little evidence-based guidance. In addition, DCI unrelated to vasospasm is difficult to monitor in patients with poor-grade SAH. New therapies for EBI and DCI unrelated to vasospasm are needed; the main target may be microcirculatory disturbances.