Browsing by Author "Dohal, Mazen Hassan"

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Narrative review of treatments for delayed cerebral ischaemia after subarachnoid haemorrhage
(Queen Mary University of London, 2024-07-31) Dohal, Mazen Hassan; Zolfaghari, PJ
Delay cerebral ischaemia (DCI) is a leading cause of death and poor neurological prognosis for individuals who survive the first bleeding episode of a burst brain aneurysm. An essential paradigm change in the knowledge of DCI aetiology has occurred due to new revelations in the ten years prior. Early brain damage, microcirculatory disorder, reduced autoregulation, or spreading depolarisation are currently the focus of emerging theories that question large-vessel cerebral vasospasm as the main causative mechanism. Optimising blood circulation and heart health, in addition to administering nimodipine, are the mainstays of DCI prevention. In order to diagnose and treat DCI early, neurological surveillance is crucial. For patients with excellent grades, the standard monitoring paradigm consists of serial clinical examinations supplemented with periodic transcranial Doppler ultrasonography, and cardiac computed tomography (with or without perfusion). Although lethargy and unconsciousness lessen susceptibility to the consequences of ischaemia, poor grade individuals (WFNS levels 4 and five) require more sophisticated monitoring. It is possible to enhance situational awareness in the detection of DCI by increasing the use of CT haemodynamic scans, constant electroencephalogram, and invasive brain multiple mediums surveillance. First-line treatment for DCI is pharmacologically-induced antihypertensive with augmentation; seventy percent of patients have a positive clinical response and the presenting impairment is reversed with this approach. When these methods do not alleviate the symptoms of medically resistant DCI, the next step is to gradually increase the dosage of rescue medication. Heart output optimisation, haemoglobin optimisation, and interventional treatment (including catheterisation and intra-arterial vaso injection) make up level 1 emergency treatment. Level 2 rescue treatments are also being examined in very resistant instances, however none of these have been shown to work. The present state of the art in DCI leadership is summarised in this evaluation.
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