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Clinical Updates and Perspectives on Subarachnoid Hemorrhage
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Clinical Updates and Perspectives on Subarachnoid Hemorrhage

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 20 September 2025 | Viewed by 712

Special Issue Editor

Dr. Fusao Ikawa

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Guest Editor
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Interests: subarachnoid hemorrhage; outcome of subarachnoid hemorrhage; delayed cerebral ischemia, ruptured cerebral aneurysm; unruptured cerebral aneurysm; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Subarachnoid hemorrhage (SAH) is a severe condition with a mortality rate of approximately 35%. However, unlike ischemic stroke, the treatment outcomes for SAH have not significantly improved. The management of post-SAH brain injury and delayed cerebral ischemia (DCI) remains inadequate. The prognosis of SAH is influenced not only by the neurological severity at onset and surgical outcomes but also by the occurrence of delayed cerebral ischemia. Therefore, improving the treatment of DCI is crucial for enhancing the prognosis of SAH.

The etiology of DCI following SAH involves not only cerebral vasospasm but also primary brain injury, increased intracranial pressure, microcirculatory disturbances, microthrombosis, blood–brain barrier disruption, and cortical spreading ischemia. Therefore, a comprehensive prevention and treatment strategy is essential.

Japan has a higher incidence of SAH compared to the global average, suggesting that preventive measures against SAH in Japan may be insufficient. Risk factors for SAH include hypertension, smoking, alcohol abuse, and the use of certain drugs. Factors more prevalent among the Japanese population include genetics, aging, high smoking rates, and a higher detection rate of SAH, though these are not definitively identified.

This Special Issue calls for original research utilizing novel data to address the aforementioned issues.

Dr. Fusao Ikawa
Guest Editor

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Keywords

  • subarachnoid hemorrhage
  • outcome of subarachnoid hemorrhage
  • delayed cerebral ischemia,
  • ruptured cerebral aneurysm
  • unruptured cerebral aneurysm
  • artificial intelligence
  • epidemiology

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Published Papers (1 paper)

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Research

16 pages, 478 KiB  
Article
Spinal Drainage and Combined Pharmacotherapy as Potential Strategies to Improve Outcomes for Patients with Poor-Grade Subarachnoid Hemorrhage Treated with Clipping or Coiling but Not Receiving Nimodipine
by Koichi Hakozaki, Fumihiro Kawakita, Kazuaki Aoki, Hidenori Suzuki and pSEED Group
J. Clin. Med. 2025, 14(8), 2715; https://doi.org/10.3390/jcm14082715 - 15 Apr 2025
Viewed by 242
Abstract
Background/Objectives: The outcome for aneurysmal subarachnoid hemorrhage (SAH) remains poor, particularly for patients presenting with World Federation of Neurological Surgeons (WFNS) grades IV–V. This study was designed to identify independent prognostic factors in this group of patients with poor-grade SAH. Methods: [...] Read more.
Background/Objectives: The outcome for aneurysmal subarachnoid hemorrhage (SAH) remains poor, particularly for patients presenting with World Federation of Neurological Surgeons (WFNS) grades IV–V. This study was designed to identify independent prognostic factors in this group of patients with poor-grade SAH. Methods: We prospectively analyzed 357 SAH patients with admission WFNS grades IV–V enrolled in nine primary stroke centers in Mie prefecture, Japan, from 2013 to 2022. This study compared clinical variables, including treatments for angiographic vasospasm and delayed cerebral ischemia (DCI), between patients with favorable (modified Rankin Scale [mRS] scores 0–2) and unfavorable (mRS scores 3–6) outcomes at 90 days post-onset. Multivariate analyses were then performed to identify independent determinants of favorable 90-day outcomes, followed by propensity score matching analyses. Results: The median age was 68 years, and 53.5% of patients had admission WFNS grade V. DCI occurred in 12.9% of patients, and 66.9% had unfavorable outcomes. Independent variables related to unfavorable outcomes were older age, admission WFNS grade V, ventricular drainage, edaravone administration, and delayed cerebral infarction, while those for favorable outcomes were spinal drainage (adjusted odds ratio [aOR] 6.118, 95% confidence interval [CI] 2.687–13.927, p < 0.001), modified Fisher grade 3 (aOR 2.929, 95% CI 1.668–5.143, p < 0.001), and triple prophylactic anti-DCI medication consisting of cilostazol, fasudil hydrochloride and eicosapentaenoic acid (aOR 1.869, 95% CI 1.065–3.279, p = 0.029). Nimodipine is not approved in Japan, and statin and cerebral vasospasm did not influence outcomes. As spinal drainage and the triple prophylactic anti-DCI medication were intervenable variables, propensity score matchings were performed, and they confirmed that both spinal drainage and the triple prophylactic anti-DCI medication were useful to achieve favorable outcomes. Conclusions: In poor-grade SAH, spinal drainage and the triple prophylactic anti-DCI medication may be effective in improving outcomes, possibly by suppressing DCI pathologies other than cerebral vasospasm. Full article
(This article belongs to the Special Issue Clinical Updates and Perspectives on Subarachnoid Hemorrhage)
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