The Rheology of Subarachnoid Hemorrhage

Abstract

n 1976, Kosnick and Hunt published an initial series of 7 patients with subarachnoid hemorrhage and symptomatic I ischemia treated with albumin, blood transfusion, and norepinephrine to increase systemic blood pressure. Six of 7 patients greatly improved, and so started the paradigm of hypertension, hypervolemia, and hemodilution (“triple-H therapy”) for the treatment of patients with symptomatic vasospasm. In the next 4 decades, there were significant improvements in the surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage, development of neurocritical care, and greater understanding of the pathophysiology of cerebral vasospasm and delayed ischemic deficit, all of which have improved outcomes. However, subarachnoid hemorrhage continues to have a 17% case fatality, and only 50% of patients have a good outcome as defined by modified Rankin Scale score 0e1.