Cortical spreading depolarizations (SD) are strongly associated with worse tissue injury and clinical outcomes in the setting of aneurysmal subarachnoid hemorrhage (SAH). Animal studies have suggested a causal relationship, and new therapies to target SDs are starting to be tested in clinical studies. A recent set of single-center randomized trials assessed the effect of the phosphodiesterase inhibitor cilostazol in patients with SAH. Cilostazol led to improved functional outcomes and SD-related metrics in treated patients through a putative mechanism of improved cerebral blood flow. Another promising therapeutic approach includes attempts to block SDs with, for example, the NMDA receptor antagonist ketamine. SDs have emerged not only as a therapeutic target but also as a potentially useful biomarker for brain injury following SAH. Additional clinical and preclinical experimental work is greatly needed to assess the generalizability of existing therapeutic trials and to better delineate the relationship between SDs, SAH, and functional outcome.

中文翻译：

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广泛的去极化和蛛网膜下腔出血。

在动脉瘤性蛛网膜下腔出血（SAH）的情况下，皮质扩散去极化（SD）与组织损伤加重和临床结局密切相关。动物研究表明存在因果关系，针对目标SD的新疗法已开始在临床研究中进行测试。最近的一组单中心随机试验评估了磷酸二酯酶抑制剂西洛他唑对SAH患者的作用。西洛他唑通过改善脑血流量的推定机制，改善了治疗患者的功能结局和与SD相关的指标。另一种有希望的治疗方法包括尝试用例如NMDA受体拮抗剂氯胺酮阻断SD。SD不仅已成为治疗目标，而且已成为SAH后脑损伤的潜在有用生物标志物。