Iron Hemostasis in Patients With Subarachnoid Hemorrhage and the Role of Early CSF Drainage

Neurology, vol. 105, pp. e213767

Abstract

Early brain injury and delayed cerebral ischemia are combined intricate processes, and they represent the principal cause of subarachnoid hemorrhage (SAH)-related morbidity and mortality worldwide. Recent studies have shown that early lumbar CSF drainage can be used to decrease the incidence of delayed cerebral ischemia and improve long-term outcome. This approach has provided novel insights into post-SAH management that lessened the burden of secondary infarction and decreased the rate of unfavorable outcome. Given that the evaluation of this approach is contingent on prospective trial and early-stage randomized clinical trial, we review insights from studies that have elucidated the mechanisms underlying deterioration in SAH. We explore the role of iron homeostasis in the restoration of normal CSF circulation and the stabilization of optimal cerebral physiology to alleviate early brain injury and delayed neurologic impairment after SAH to advance the current understanding of SAH management.

Authors 3

1. Henner Koch Aachen Medical Faculty Department of Epileptology, Neurology

   RWTH Aachen University

   Affiliation as printed

   Department of Epileptology, Neurology, Medical Faculty, RWTH Aachen University, Germany

2. Benedikt Kremer Aachen Department of Neurosurgery, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Germany; and

3. Anke Höllig Aachen Department of Neurosurgery, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Germany; and