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The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage
 
 
Review

Neuroprotective Strategies in Aneurysmal Subarachnoid Hemorrhage (aSAH)

1
Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany
2
Department of Neurosurgery, Helios-Amper Klinikum Dachau, Krankenhausstr. 15, 85221 Dachau, Germany
3
Department of Neurosurgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
*
Authors to whom correspondence should be addressed.
Joint first authors with equal contributions.
Academic Editor: Rolf Heumann
Int. J. Mol. Sci. 2021, 22(11), 5442; https://doi.org/10.3390/ijms22115442
Received: 17 March 2021 / Revised: 30 April 2021 / Accepted: 18 May 2021 / Published: 21 May 2021
Aneurysmal subarachnoid hemorrhage (aSAH) remains a disease with high mortality and morbidity. Since treating vasospasm has not inevitably led to an improvement in outcome, the actual emphasis is on finding neuroprotective therapies in the early phase following aSAH to prevent secondary brain injury in the later phase of disease. Within the early phase, neuroinflammation, thromboinflammation, disturbances in brain metabolism and early neuroprotective therapies directed against delayed cerebral ischemia (DCI) came into focus. Herein, the role of neuroinflammation, thromboinflammation and metabolism in aSAH is depicted. Potential neuroprotective strategies regarding neuroinflammation target microglia activation, metalloproteases, autophagy and the pathway via Toll-like receptor 4 (TLR4), high mobility group box 1 (HMGB1), NF-κB and finally the release of cytokines like TNFα or IL-1. Following the link to thromboinflammation, potential neuroprotective therapies try to target microthrombus formation, platelets and platelet receptors as well as clot clearance and immune cell infiltration. Potential neuroprotective strategies regarding metabolism try to re-balance the mismatch of energy need and supply following aSAH, for example, in restoring fuel to the TCA cycle or bypassing distinct energy pathways. Overall, this review addresses current neuroprotective strategies in aSAH, hopefully leading to future translational therapy options to prevent secondary brain injury. View Full-Text
Keywords: subarachnoid hemorrhage (SAH); inflammation; thromboinflammation; metabolism; neuroprotection; therapy subarachnoid hemorrhage (SAH); inflammation; thromboinflammation; metabolism; neuroprotection; therapy
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MDPI and ACS Style

Weiland, J.; Beez, A.; Westermaier, T.; Kunze, E.; Sirén, A.-L.; Lilla, N. Neuroprotective Strategies in Aneurysmal Subarachnoid Hemorrhage (aSAH). Int. J. Mol. Sci. 2021, 22, 5442. https://doi.org/10.3390/ijms22115442

AMA Style

Weiland J, Beez A, Westermaier T, Kunze E, Sirén A-L, Lilla N. Neuroprotective Strategies in Aneurysmal Subarachnoid Hemorrhage (aSAH). International Journal of Molecular Sciences. 2021; 22(11):5442. https://doi.org/10.3390/ijms22115442

Chicago/Turabian Style

Weiland, Judith, Alexandra Beez, Thomas Westermaier, Ekkehard Kunze, Anna-Leena Sirén, and Nadine Lilla. 2021. "Neuroprotective Strategies in Aneurysmal Subarachnoid Hemorrhage (aSAH)" International Journal of Molecular Sciences 22, no. 11: 5442. https://doi.org/10.3390/ijms22115442

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