Q: Out of following, which one has shown to decrease vasospasm after sub-arachnoid hemorrhage SAH)?

A) Hydralazine
B) Beta blocker
C) Clonidine
D) Statin
E) Vitamin B6


Answer: D

Guidelines from the American Stroke Society recommends to administer statin therapy to patients after SAH to prevent vasospasm, after few trials showed that statin treatment is beneficial for preventing vasospasm and improving outcome after SAH. The mechanism is uncertain. Recommended dose is either pravastatin 40 mg daily or simvastatin 80 mg daily within 48 hours of diagnosis of aneurysmal SAH.




References: 

1. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 2012; 43:1711.

2. McGirt MJ, Lynch JR, Parra A, et al. Simvastatin increases endothelial nitric oxide synthase and ameliorates cerebral vasospasm resulting from subarachnoid hemorrhage. Stroke 2002; 33:2950.

3. Lynch JR, Wang H, McGirt MJ, et al. Simvastatin reduces vasospasm after aneurysmal subarachnoid hemorrhage: results of a pilot randomized clinical trial. Stroke 2005; 36:2024.

4. Sillberg VA, Wells GA, Perry JJ. Do statins improve outcomes and reduce the incidence of vasospasm after aneurysmal subarachnoid hemorrhage: a meta-analysis. Stroke 2008; 39:2622.

5. Liu Z, Liu L, Zhang Z, et al. Cholesterol-reducing agents for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2013; 4:CD008184.