All patients who present with subarachnoid hemorrhage should be admitted to the intensive care unit for close neurologic and cardiorespiratory monitoring. Neurosurgical consultation should be obtained if external ventricular drain placement, arteriography, or surgical planning are considered. Seizure prophylaxis, antihypertensive treatment for mean arterial blood pressure greater than 130 mm Hg, pain control, and bed rest are important measures for the prevention of rebleeding, which is associated with a high mortality rate. Standard deep venous thrombosis and gastrointestinal prophylaxis are recommended to prevent medical complications associated with critical illness. In patients with good-grade subarachnoid hemorrhage, early arteriography and definitive aneurysm management are recommended. The location and neck size of the aneurysm and the medical condition of the patient are factors in the decision to proceed with surgical rather than interventional aneurysm management. Postoperatively, clinical examination and transcranial Doppler ultrasonography are recommended for surveillance of vasospasm. If clinical or arteriographic evidence of vasospasm is present, hemodilution, hypertension, and hypervolemia (triple H) therapy should be instituted. If vasospasm is resistant to conservative measures, balloon angioplasty or intra-arterial papaverine therapy should also be considered.
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References and Recommended Reading
- 2.Drake CG: Report of the World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 1988, 68:985–986.Google Scholar
- 7.Tetterborn D, Dycka J: Prevention and treatment of delayed ischemic dysfunction in patients with aneurysmal subarachnoid hemorrhage. Stroke 1990, 21(suppl IV):IV85-IV89.Google Scholar
- 9.Vinuela F, Duckwiler G, Guglielmi G: Principles of interventional neuroradiology. In Cerebrovascular Disease. Edited by Batjer, HH. Philadelphia: Lippincott-Raven; 1997:699–701.Google Scholar
- 11.MacDonald RL: Cerebral vasospasm. Neurosurg Q 1995, 5:73–97.Google Scholar
- 12.Bejjani G, Bank W, Olan W, Sekhar L: The efficacy and safety of angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 1998, 42:979–987. This retrospective study discusses the safety, efficacy, and timing of angioplasty for cerebral vasospasm and reviews the current literature.PubMedCrossRefGoogle Scholar
- 18.Maekawa T, Tateishi A, Sadamitsu D, et al.: Clinical application of mild hypothermia in neurological disorders. Minerva Anestesiol 1994, 64:537–540.Google Scholar