Medicine and Health

Pathophysiology of Early Brain Injury and Its Association with Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Review of Current Literature

D. L. Alsbrook, M. D. Napoli, et al.

Discover how delayed cerebral ischemia (DCI) is intricately linked to early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (aSAH). This cutting-edge review unveils new predictive models and potential therapeutic targets for enhancing patient outcomes. Conducted by a diverse team of experts, this research shines a light on vital mechanisms that could change the future of aSAH treatment.

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~3 min • Beginner • English

Index

Abstract

Background: Delayed cerebral ischemia (DCI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH). Despite trials targeting DCI, vasospasm, and rebleeding risk reduction, outcomes have not substantially improved. We provide an up-to-date review of the pathophysiology of DCI and its association with early brain injury (EBI). Recent findings: Emerging evidence indicates that EBI, rather than delayed injury alone, is the principal driver of downstream mechanisms leading to DCI. New predictive models, advanced monitoring, and neuroimaging can detect EBI and potentially enhance management. Summary: EBI severity, SAH burden, and physiologic/imaging markers may identify candidates for early therapeutics. Focus on microcellular milieu and hemodynamic pathomechanisms is warranted. Advancements in understanding DCI pathophysiology may translate into improved outcomes for this patient population.

Publisher

Journal of Clinical Medicine

Published On

Jan 28, 2023

Authors

Diana L Alsbrook, Mario Di Napoli, Kunal Bhatia, Masoom Desai, Archana Hinduja, Clio A Rubinos, Gelsomina Mansueto, Puneetpal Singh, Gustavo G Domeniconi, Asad Ikram, Sara Y Sabbagh, Afshin A Divani

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