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(Stroke. 2009;40:S86.)
© 2009 American Heart Association, Inc.

Brain Hemorrhage

Subarachnoid Hemorrhage

Is It Time for a New Direction?

From the Departments of Physiology and Neurosurgery, Loma Linda University Medical School, Loma Linda, Calif; and Department of Neurology, Chongqing Medical University, China.

Correspondence to John H. Zhang MD, PhD, Division of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson St, Room 2562B, Loma Linda, CA 92354. E-mail johnzhang3910{at}yahoo.com

Background and Purpose— Despite recent advances in the treatment of patients after subarachnoid hemorrhage, morbidity and mortality rates have failed to improve significantly. Although this was often blamed on vasospasm, is it time to consider alternative etiologies?

Summary of Review— Early brain injury (EBI) is a recently described term that describes the immediate injury to the brain after subarachnoid hemorrhage. A number of pathways have been recognized as having a role in the etiology of EBI. This review provides a brief synopsis of EBI and its implications for the future.

Conclusions— EBI may be responsible for the detrimental effects seen in patients after subarachnoid hemorrhage. Additional studies are needed to determine the pathophysiology of EBI and to explore potential therapeutic options.

Key Words: apoptosis • subarachnoid hemorrhage • vasospasm • early brain injury