Medical complications after subarachnoid hemorrhage: new strategies for prevention and management.

PURPOSE OF REVIEW: To summarize new concepts regarding the occurrence, prevention, and management of medical complications following subarachnoid hemorrhage.

RECENT FINDINGS: Data regarding the impact of common medical complications after subarachnoid hemorrhage on delayed cerebral ischemia and neurological outcome after subarachnoid hemorrhage are available from recent outcomes studies. Fever, anemia requiring transfusion, hyperglycemia, electrolyte abnormalities, pneumonia, hypertension, and neurogenic stunned myocardium and pulmonary edema occur frequently after subarachnoid hemorrhage. Fever, anemia, hyperglycemia, and acute hypoxia and hypotension related to neurogenic stunned myocardium have the greatest impact on mortality and functional outcome after subarachnoid hemorrhage. Potential treatment interventions for these complications include the development of acute resuscitation strategies to optimize cerebral perfusion in poor-grade patients, maintaining normothermia with systemic cooling devices, administration of erythropoietin to prevent severe anemia, preserving normoglycemia with continuous insulin infusions, and goal-directed hemodynamic support guided by brain tissue oxygenation.

SUMMARY: Clinical trials to investigate interventions targeted at preventing or treating common medical complications after subarachnoid hemorrhage are needed.