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Pharmacologically targeting inflammation and improving cerebrospinal fluid circulation improves outcome after subarachnoid haemorrhage.

EBioMedicine. 2022 Mar;77:103937. doi: 10.1016/j.ebiom.2022.103937. Epub 2022 Mar 13. PMID: 35290830; PMCID: PMC8921540.

Authors/Editors: Zille M, Plesnila N, Boltze J.
Publication Date: 2022

Subarachnoid haemorrhage (SAH) is a feared type of haemorrhagic stroke characterised by high mortality (around 35%) and morbidity with only about 30% of patients being able to return to independent living. Acute or delayed cerebral ischemia resulting in further neurological deterioration and caused by severe arterial vasospasms in the macro- and microvasculature significantly contributes to poor SAH outcome. The exact mechanisms causing these vasospasms are not well understood, but it is believed that coagulation factors, haemoglobin breakdown products and in particular free iron from haemolytic erythrocytes are involved. Blood breakdown products have also been identified as a potent inflammatory stimulus and can cause widespread neuronal damage and death. Moreover, blood clots forming in the subarachnoid space are associated with disturbed cerebrospinal fluid (CSF) circulation leading to intracranial pressure increases, oedema formation, and hydrocephalus. Timely surgical intervention to prevent re-bleeding is a key element of SAH treatment, however, few other causal treatments are available yet. Hence, additional treatment options supporting surgical interventions are urgently needed to improve outcome after SAH.


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