Cerebral vasospasm following subarachnoid hemorrhage (SAH):
Cerebral vasospasm and the delayed cerebral ischemia remain a source of substantial morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Hemodynamic manipulation better known as ‘triple H’ therapy is routinely used in the management of patients with acute vasospasmfollowing SAH. The rationale of inducing hypertension, hypervolemia and hemodilution is to improve blood flow to the injured brain and to prevent secondary ischemia. While the Ca2+ antagonist Nimodipine is still the only drug with proven benefit on neurologic outcome following SAH, several alternatives are under research. Tirilazad is not effective, and studies of hemodynamic maneuvers, magnesium, statin medications, endothelin antagonists, steroid drugs, anticoagulant/antiplatelet agents, and intrathecal fibrinolytic drugs have yielded inconclusive and controversial results. Steroids drugs and anticoagulant/antiplatelet agents have been abandoned so far, because of the lack of efficacy. The purpose of the present paper is to provide a systematic review of the existing literature on the treatment of cerebral vasospasm.