Cerebral vasospasm is a major source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Evidence suggests a multifactorial etiology and this concept remains supported by the assortment of therapeutic modalities under investigation. The authors provide an updated review of the literature for previous and recent clinical trials evaluating medical treatments in patients with cerebral vasospasm secondary to aSAH. Currently, the strongest evidence supports use of prophylactic oral nimodipine and initiation of triple-H therapy for patients in cerebral vasospasm. Other agents presented in this report include magnesium, statins, endothelin receptor antagonists, nitric oxide promoters, free radical scavengers, thromboxane inhibitors, thrombolysis, anti-inflammatory agents and neuroprotectants. Although promising data is beginning to emerge for several treatments, few prospective randomized clinical trials are presently available. Additionally, future investigational efforts will need to resolve discrepant definitions and outcome measures for cerebral vasospasm in order to permit adequate study comparisons. Until then, definitive recommendations cannot be made regarding the safety and efficacy for each of these therapeutic strategies and medical management practices will continue to be implemented in a wide-ranging manner. 1. Introduction Aneurysmal subarachnoid hemorrhage (aSAH) occurs in approximately 30,000 patients in the United States each year [1]. Cerebral vasospasm is estimated to occur in up to 70% of all aSAH patients and remains a major cause of morbidity and mortality [2]. The complex cascade of factors and events that result in arterial narrowing has been subject to extensive research, leading to a vast array of proposed treatment methods. A large number of these experimental therapies have been evaluated at the basic and translational levels with fewer reported prospective randomized clinical trials. Despite these efforts, no single treatment modality has proven efficacious and trial results have been frequently mixed or conflicting. Therefore medical management practices are often wide-ranging with an assortment of strategies implemented in various permutations. In this report, we review the literature and provide a concise, updated summary of recent clinical trials and current medical treatments evaluated in patients with cerebral vasospasm secondary to aSAH. 2. Triple-H Therapy The current mainstay for medical management of vasospasm secondary to aSAH remains triple-H therapy. The protocol is defined by
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