Update of the Pharmacologic Management of Aneurysmal Subarachnoid Hemorrhage

Required reading for all learners: Implicit Bias impacts patient outcomes

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. Despite advances in early diagnosis and improvements in neurocritical care, mortality remains high; the 90-day case-fatality rate is close to 30%. 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. 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 includes seizures, elevated intracranial pressure, and vasospasm leading to delayed cerebral ischemia. The purpose of this article is to describe contemporary pharmacologic strategies used to treat aneurysmal SAH.