Incremental Versus Immediate Induction of Hypertension in the Treatment of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: Invited Commentary

In the context of cerebrovascular accidents, subarachnoid hemorrhage is a less frequent, but very often dramatic, occurrence that mainly affects young and productive-age patients. It is a complex disease that the clinician tends to delegate, in most cases, to a specialist environment. It is a complex pathology with various types of complications: cerebral and systemic, early and late. The precocious ones can be strictly cerebral, can be grouped in the concept of early brain injury, and can include endothelial damage, vasospasm, microspasm, alteration of the blood–brain barrier, hydrocephalus. They can also be systemic, such as in the stress cardiomyopathy of Takotsubo or the neurogenic pulmonar edema. Among the later complications, cerebral conditions fall within a symptom complex called delay cerebral ischemia (DCI), which can include phenomena such as spreading depolarization, cerebral tissue oxygenation deficits, and cerebral infarction. The treatment of this pathologic condition is greatly influenced by the health resources available, and only in a relatively few centers in the world is it possible to diagnose and treat these complications in the best possible way, beyond the initial golden hour and interventional treatment. In settings in which complications are not promptly diagnosed and treated, patients die or have a much worse outcome. …