Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review

William S. Dodd; Dimitri Laurent; Aaron S. Dumont; David M. Hasan; Pascal M. Jabbour; Robert M. Starke; Koji Hosaka; Adam J. Polifka; Brian L. Hoh; Nohra Chalouhi

doi:10.1161/JAHA.121.021845

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Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review

Journal article

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Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review

William S. Dodd, Dimitri Laurent, Aaron S. Dumont, David M. Hasan, Pascal M. Jabbour, Robert M. Starke, Koji Hosaka, Adam J. Polifka, Brian L. Hoh and Nohra Chalouhi

Journal of the American Heart Association, Vol.10(15), pp.e021845-e021845

08/03/2021

DOI: 10.1161/JAHA.121.021845

PMCID: PMC8475656

PMID: 34325514

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Abstract

Delayed cerebral ischemia is a major predictor of poor outcomes in patients who suffer subarachnoid hemorrhage. Treatment options are limited and often ineffective despite many years of investigation and clinical trials. Modern advances in basic science have produced a much more complex, multifactorial framework in which delayed cerebral ischemia is better understood and novel treatments can be developed. Leveraging this knowledge to improve outcomes, however, depends on a holistic understanding of the disease process. We conducted a review of the literature to analyze the current state of investigation into delayed cerebral ischemia with emphasis on the major themes that have emerged over the past decades. Specifically, we discuss microcirculatory dysfunction, glymphatic impairment, inflammation, and neuroelectric disruption as pathological factors in addition to the canonical focus on cerebral vasospasm. This review intends to give clinicians and researchers a summary of the foundations of delayed cerebral ischemia pathophysiology while also underscoring the interactions and interdependencies between pathological factors. Through this overview, we also highlight the advances in translational studies and potential future therapeutic opportunities.

Details

Title: Subtitle: Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review
Creators: William S. Dodd - Department of Neurosurgery College of Medicine University of Florida Gainesville FL
Dimitri Laurent - University of Florida
Aaron S. Dumont - Tulane University
David M. Hasan - University of Iowa
Pascal M. Jabbour - Thomas Jefferson University
Robert M. Starke - University of Miami
Koji Hosaka - University of Florida
Adam J. Polifka - University of Florida
Brian L. Hoh - University of Florida
Nohra Chalouhi - University of Florida
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.10(15), pp.e021845-e021845
DOI: 10.1161/JAHA.121.021845
PMID: 34325514
PMCID: PMC8475656
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Language: English
Date published: 08/03/2021
Academic Unit: Roy J. Carver Department of Biomedical Engineering
Record Identifier: 9984419022802771

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