Update of the Pharmacologic Management of Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage (SAH) is a subtype of hemorrhagic stroke associated with significant morbidity and mortality. It is defined by bleeding into the subarachnoid space after the rupture of a cerebral artery aneurysm.¹  Aneurysmal SAH accounts for roughly 3% of all strokes and has an incidence of 6 per 100000 persons per year worldwide.¹  Despite advances in early diagnosis and improvements in neurocritical care, mortality remains high; the 90-day case-fatality rate is close to 30%.²  Long-term morbidity is significant, with roughly half of patients failing to return to baseline level of functioning and a quarter of patients requiring long-term assistance with activities of daily living.²  Treatment of aneurysmal SAH centers on limiting early rebleeding with subsequent monitoring and pharmacologic management of complications. After initial stabilization, the major complications of aneurysmal SAH include seizures, elevated intracranial pressure, and vasospasm leading to delayed cerebral ischemia.³  The purpose...