Critically evaluate the current approaches to the treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage.
Treatment
b) Triple H therapy-HT, hypervolemia and hemodilution-controversial, not evidence based
c) Early clipping / coiling
d) Nimodipine -useful in prophylaxis,
e) Endoluminal·therapies: Balloon angioplasty and intra-arterial papaverine
Investigational therapies -proven in animal models, no hard clinical evidence, no RCT
1) Statins-Early human data
2) Cisternal tPa
3) Endothelin antagonists
This topic is well developed in the chapter on subarachnoid haemorrhage.
True to the college answer, there is only strong evidence for nimodipine and endovascular vasodilators. Of the "triple-H" therapy, the only evidence-based component is probably hypertension, and even this is being debated.
Judging by the college answer, they did not want a discussion of Class I recommendations from highly regarded advisory bodies. The model answer mentions some wacky "failed therapies" for vasospasm which have subsequently receded into historical background noise.
In summary:
Well-supported therapies
Poorly supported therapies
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