Subarachnoid hemorrhage treatment

Tseng MY, Czosnyka M, Richards H, Pickard JD, Kirkpatrick PJ. Effects of acute treatment with pravastatin on cerebral vasospasm, autoregulation, and delayed ischemic deficits after aneurysmal subarachnoid hemorrhage a phase II randomized placebo-controlled trial. Stroke 2005 36 1627-1632. 

There is no proven treatment for intracerebral hemorrhage. Management is based on neurointensive care treatment and prevention of complications. Oral nimodipine is recommended in subarachnoid hemorrhage to prevent delayed cerebral ischemia. 

Nitrendipine and felodipine are used in the treatment of hypertension. Ni-modipine is given prophylactically after subarachnoidal hemorrhage to prevent vasospasms due to depolarization by excess K liberated from disintegrating erythrocytes or blockade of NO by free hemoglobin. 

Unlabeled Uses Treatment of associafed neurologic deficits, Raynaud s phenomenon, subarachnoid hemorrhage, vasospastic angina... 

Unlabeled Uses Prevention of postoperative deep vein thrombosis (DVT), protection of aortocoronary bypass grafts, reduction of graft loss after renal transplant, treatment of intermittent claudication, sickle cell disease, subarachnoid hemorrhage, diabetic microangiopathy, ischemic heart disease... 

An immediately life-threatening disease means a stage of a disease in which there is a reasonable likelihood that death will occur within a matter of months, or in which premature death is likely without early treatment. For example, advanced cases of AIDS, herpes simplex encephalitis, and subarachnoid hemorrhage are all considered immediately life-threatening diseases. Treatment INDs are made available to patients before general marketing begins, typically... 

Hellingman CA, van den Bergh WM, Beijer IS et al. (2007). Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage. Stroke 38 96-99... 

Niemann DB, Wills AD, Maartens NF et al. (2003). Treatment of intracerebral hematomas caused by aneurysm rupture coil placement followed by clot evacuation. Journal of Neurosurgery 99 843-847 Olafsson E, Gudmundsson G, Hauser WA (2000). Risk of epilepsy in long-term survivors of surgery for aneurysmal subarachnoid hemorrhage a population-based study in Iceland. Epilepsia 41 1201-1205... 

Wermer MJ, Kool H, Albrecht KW et al. (2007). Aneurysm Screening after Treatment for Ruptured Aneurysms Study Group. Subarachnoid hemorrhage treated with clipping long-term effects on employment, relationships, personality and mood. Neurosurgery 60 91-97... 

For subarachnoid hemorrhage surgical clipping of the causative aneurysm or resection of the arteriovenous malformation is the mainstay of treatment. Endovascular coiling of the aneurysm can also be performed. Post-operative infection (either brain or respiratory) is an uncommon complication and not believed to be any more common than after other invasive surgical procedures. Hypervolemic-hemodilution and hypertensive (HHH) therapy is used to prevent spasm. There may be a role for anti-inflammatory measures for the prevention of vasospasm and delayed cerebral ischemia, as shown in a recent pilot study of patients treated with statins (Lynch et al., 2005). 

Massive pulmonary thromboembohsm was reported in a 62-year-old woman seven days after treatment with high doses for subarachnoid hemorrhage (53). 

Roos Y. Antifibrinolytic treatment in subarachnoid hemorrhage a randomized placebo-controlled trial. STAR Study Group. Neurology 2000 54(l) 77-82. 

There are 10 calcium channel blockers available today in the United States. As a diverse class of drugs, they have many roles in the treatment of cardiovascular diseases. One calcium channel blocker, nimodipine, also has a specific role in treating subarachnoid hemorrhages. 

There are several potential causes for segmental necrosis of muscle fiber. The cause of this type of necrosis is not well understood but could be due to effects on the plasma membrane or the outer boundary of the muscle fiber. Aminocaproic acid (an antifibrinolytic medication used in the treatment of a subarachnoid hemorrhage), clofibrate (used to treat hyperlipedemia), emetine (found in ipecac syrup), cardiac glycosides, heroin, and phencyclidine have been associated with necrotizing myopathies. 

An additional area of potentially fruitful research is in the area of central Ca channel modulation. Nimodipine, a centrally acting Ca " channel antagonist marketed in the United States by Bayer AG for the treatment of subarachnoid hemorrhage, is known to protect against the cognitive impairment that normally follows cerebral insult (550). This effect is thought to be attributed to the ability of nimodipine to normalize the function of intra-... 

Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group. J Neurosurg 1996 85 82-89. 

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