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Delayed cerebral ischaemia after subarachnoid haemorrhage: pathophysiology, diagnosis and neurotherapeutic opportunities
Thilak, S. Brown, P. Lawrence, E. Gopal, S. Mullhi, R. Chacko, C. Ahmed, Z. Chelvarajah, R. Pooni, J.
Thilak, S.
Brown, P.
Lawrence, E.
Gopal, S.
Mullhi, R.
Chacko, C.
Ahmed, Z.
Chelvarajah, R.
Pooni, J.
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Epub Date
Issue Date
2025-04-14
Submitted date
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Abstract
Delayed cerebral ischaemia is a serious complication following aneurysmal subarachnoid haemorrhage (aSAH), leading to poor outcomes. This review discusses the pathophysiology of DCI, focusing on the role of cerebral vasospasm, reduction in the cerebral blood flow and the factors that affect the vasospasm and DCI. Biomarkers play a crucial role in DCI's recognition, risk stratification, and outcome prediction. Goal-directed management aims to ameliorate the reduced cerebral blood flow, restore circulation and substrate delivery, and protect neurons. These strategies include the maintenance of cerebral blood flow and restoring substrate delivery by optimising oxygenation and maintaining normoglycaemia. Neuroprotective agents, such as calcium channel blockers like nimodipine, play a crucial role by reducing neuronal calcium influx and improving collateral circulation. Multimodal monitoring, incorporating techniques like transcranial Doppler, continuous EEG, and intracranial pressure monitoring, is essential for guiding treatment decisions and evaluating the efficacy of interventions. In the future, research should focus on a comprehensive approach to DCI management with pharmacological interventions and individualised treatment strategies.
Citation
Thilak, S., Brown, P., Lawrence, E. et al. (2025) Delayed cerebral ischaemia after subarachnoid haemorrhage: pathophysiology, diagnosis and neurotherapeutic opportunities. Discover Medicine 2, 103. https://doi.org/10.1007/s44337-025-00302-z
Publisher
Journal
Research Unit
PubMed ID
41835314 (pubmed)
PubMed Central ID
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Type
Journal article
Language
en
Description
© 2025 The authors. Published by Springer. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1007/s44337-025-00302-z
Series/Report no.
ISSN
3004-8885
EISSN
3004-8885