Anti-inflammatory agents and cerebral vasospasm.

Delayed cerebral ischemia ascribed to vasospasm remains the largest source of morbidity and mortality today in patients who survive the initial effects of an aneurysmal subarachnoid hemorrhage. Although the cause or causes of vasospasm remain unknown, mounting evidence links its occurrence to the inflammatory response that occurs following subarachnoid hemorrhage. Animal and preliminary clinical studies suggest that both steroidal and nonsteroidal anti-inflammatory agents may be of benefit following subarachnoid hemorrhage. The clinical use of these agents has largely been limited by the concern that they may produce unwanted and serious side effects. As the understanding of the biology of chronic vasospasm increases, it may be possible to design more effective and safer anti-inflammatory drugs for this use.