Aneurysmal Subarachnoid Hemorrhage and Resolution of Inflammation

Abstract

Aneurysmal subarachnoid hemorrhage (SAH) is a severe life-threatening disease and an important source of neurological disability. Therapeutic interventions over the last few decades have repeatedly failed to improve functional outcome after SAH; however, resolution of inflammation has largely been ignored as a potential therapeutic target. The omega-3 fatty acids (FAs), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) are the precursors of key mediators involved in resolution of inflammation and endogenous neuroprotection. EPA also plays a major role in microvascular function, and DHA accretion in the brain is crucial for normal neuronal function. Although considerable loss of brain DHA has been identified in SAH patients, the pathological significance of this process has also been overlooked. Current Western diets provide insufficient amounts of omega-3 FAs to compensate for the loss of brain DHA following SAH. Here, we review the rationale for future clinical trials of omega-3 FAs in SAH. Furthermore, the potential role of defective resolution of inflammation in the growth and rupture of intracranial aneurysms is inferred from recent findings in atherosclerosis and nutrition. The novel concepts of resolution of inflammation and endogenous neuroprotective signaling may open new avenues for public health interventions and innovative research in intracranial aneurysms and SAH.