Despite numerous attempts, there are currently no efficient drugs to treat SAH, leaving patients with bleak prospects
Intravascular coiling or neurosurgical clipping of the aneurysm to stop the massive bleeding
Has no effect in preventing SAH complications such as delayed cerebral ischemia
Only drug approved for SAH in EU/US. Limited effects to prevent SAH complications (e.g. delayed cerebral ischemia). May decrease blood pressure, causing critical drop in brain tissue oxygenation and cerebral blood flow
Mostly to relief symptoms (pain, nausea, vomiting) but have no effect to preserve brain cells
Subarachnoid hemorrhage (SAH) is caused by blood pouring out from a ruptured cerebral artery, an aneurysm or an arterio-venous malformation into the brain tissue or into the subarachnoid space, resulting in a dramatic increase of intracranial pressure and a critical reduction of brain blood flow, in turn depriving the brain cells of necessary oxygen and nutrients. Approximately 15% of acute SAH patients die in their homes, mors subita, and of those that reach the hospital with a major SAH, another 30% die in hospital during the first week. In addition, up to 40% of the SAH patients will suffer serious brain damage while the reminder may recover partly. The first priority of the neurosurgeon is to stop the massive bleeding by intravascular coiling or neurosurgical clipping of the aneurysm. The care will involve relief of the intracranial pressure by installing an intraventricular catheter. However, the outcome is often poor, with reperfusion damage, ischemia and cell death; in other words, the patients either die or suffer serious brain damage. There is no available medicine to prevent ischemia and brain damage in these patients. Nimodipine, a calcium channel blocker, is often used to prevent vasospasm but the benefit of the treatment is limited. Nicardipine is a closely related drug which is used to control acute hypertension or in cardiac disorders. This group of calcium channel blockers may cause a drop in blood pressure in SAH patients, which may exacerbate brain damage. Corticosteroids or urea are sometimes used to reduce brain swelling.
Patients are carefully monitored at neurointensive units and receive commonly used pain-relieving medications, including morphine and a combination of codeine and paracetamol. Antiemetics, such as promethazine, are also used to prevent feeling sick and vomiting.