Inflammation inhibitors to reduce brain injury after a hemorrhagic stroke.

Important determinants of poor functional outcome after aneurysmal subarachnoid hemorrhage (SAH) are early brain injury (brain injury <72 hours after ictus) and delayed cerebral ischemia (4-14 days after the bleeding). No treatment exists to reduce early brain injury and the effects of current strategies (nimodipine, euvolemia) to prevent delayed cerebral ischemia are only modest. The inflammatory response is considered to play a key role in the pathogenesis of early brain injury and delayed cerebral ischemia after aneurysmal SAH. Previous studies found that the complement cascade is activated in patients with SAH and associated with poor functional outcome. Eculizumab is a complement C5 inhibitor that prevents the formation of C5a and C5b. In the current trial, we will investigate the biological effect and safety of eculizumab in patients with aneurysmal SAH.

Treatment with C5 antibodies decreases early brain injury and delayed cerebral ischemia in patients with aneurysmal SAH and thereby improves clinical condition.

Primary outcome measure:

1) 48-72 hours after ictus



Secondary outcome measurements:

2) Four weeks;

3 & 4) Blood plasma during hospital stay at multiple timepoints (on admission and on day 2, 4, 6, 9, 12 and 14). CSF 48-72 hours after ictus;

5) Daily during the first fourteen days of the hospital stay;

6) On day 14;

7) At discharge;

8) Ten weeks after ictus (+/- two week);

9) Thirteen weeks after ictus (+/- two weeks).

The intervention group will receive intravenous eculizumab infusions.