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Case Scenario for Fluid Management After Subarachnoid Hemorrhage in the Neuro-Intensive Care Unit

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Perioperative Fluid Management

Abstract

Subarachnoid hemorrhage is a cerebrovascular emergency with significant morbidity and mortality. The clinical presentation varies; most patients present with severe headache, nausea, vomiting and neck pain. Loss of consciousness can also happen in severe cases. Early diagnosis is essential and confirmed with a non-contrast CT of the brain with or without a lumbar puncture. The most common cause of nontraumatic subarachnoid hemorrhage is aneurysm rupture. Most patients with aneurysmal subarachnoid hemorrhage should be monitored closely in an intensive care unit after securing the aneurysm, to monitor for and prevent potential neurological and medical complications. Neurological complications include aneurysm rerupture, seizures, hydrocephalus, intracranial hypertension, and delayed cerebral ischemia, all of which can worsen outcome following subarachnoid hemorrhage. Systemic complications that can occur in these patients include acute cardiopulmonary decompensation (i.e. neurogenic pulmonary edema, estress cardiomyopathy, etc.), and hyponatremia secondary to cerebral salt wasting syndrome or syndrome of inappropriate antidiuretic hormone secretion. Close neurologic and hemodynamic monitoring and understanding of the pathophysiologic changes of this complex patient population is important to optimize patient outcome.

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Authors and Affiliations

  1. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Ibrahim Migdady, Jenny Peih-Chir Tsai & Joao A. Gomes

  2. Endovascular Surgical Neuroradiology, Cleveland Clinic, Cleveland, OH, USA

    Jenny Peih-Chir Tsai

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  2. Jenny Peih-Chir Tsai
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  3. Joao A. Gomes
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Correspondence to Jenny Peih-Chir Tsai .

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Editors and Affiliations

  1. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Ehab Farag

  2. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Andrea Kurz

  3. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Christopher Troianos

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Migdady, I., Tsai, J.PC., Gomes, J.A. (2020). Case Scenario for Fluid Management After Subarachnoid Hemorrhage in the Neuro-Intensive Care Unit. In: Farag, E., Kurz, A., Troianos, C. (eds) Perioperative Fluid Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48374-6_25

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  • DOI: https://doi.org/10.1007/978-3-030-48374-6_25

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48373-9

  • Online ISBN: 978-3-030-48374-6

  • eBook Packages: MedicineMedicine (R0)

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