Current Treatment Options in Neurology

, Volume 1, Issue 2, pp 97–112 | Cite as

Subarachnoid hemorrhage

  • Kelly D. Flemming
  • Robert D. BrownJr.
  • David O. Wiebers
Article

Opinion statement

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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Hunt WE, Hess RM: Surgical risk as related to time of intervention in repair of intracranial aneurysms. J Neurosurg 1968, 28:14–20.PubMedGoogle Scholar
  2. 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
  3. 3.
    Fisher CM, Kistler JP, Davis JM: Relationship of cerebral vasospasm to subarachnoid hemorrhage visualized by CT scanning. Neurosurgery 1980, 6:1–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Hasan D, Vermeulen M, Wijdicks EFM, et al.: Effect of fluid intake and antihypertensive treatment on cerebral ischemia after subarachnoid hemorrhage. Stroke 1989, 20:1511–1515.PubMedGoogle Scholar
  5. 5.
    Cook D, Guyatt G, Marshall J, et al.: A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med 1998, 338:791–797.PubMedCrossRefGoogle Scholar
  6. 6.
    Pickard JD, Murray GD, Illingworth R, et al.: Effect of nimodipine on cerebral infarction and outcome after subarachnoid hemorrhage: British aneurysm nimodipine trial. BMJ 1989, 298:636–642.PubMedGoogle Scholar
  7. 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
  8. 8.
    Kassell NF, Torner JC, Jane JA, et al.: The International Cooperative Study on the timing of aneurysm surgery. Part 2: surgical results. J Neurosurg 1990, 73:37–47.PubMedGoogle Scholar
  9. 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
  10. 10.
    Nelson PK, Levy D, Masters L, Bose A: Neuroendovascular management of intracranial aneurysms. Neuroimaging Clin N Am 1997, 7:739–762. This paper provides a comprehensive review of endovascular techniques and interventions.PubMedGoogle Scholar
  11. 11.
    MacDonald RL: Cerebral vasospasm. Neurosurg Q 1995, 5:73–97.Google Scholar
  12. 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
  13. 13.
    Numaguchi Y, Zoarski G: Intra-arterial papaverine treatment for cerebral vasospasm: our experience and review of the literature. Neurol Med Chir 1998, 38:189–195.CrossRefGoogle Scholar
  14. 14.
    Kassell N, Helm G, Simmons N, et al.: Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg 1992, 77:848–852.PubMedGoogle Scholar
  15. 15.
    Kassell N, Haley EC, Apperson-Hansen C, Alves W: Randomized, double-blind, vehicle-controlled trial of tirilazad mesylate in patients with aneurysmal subarachnoid hemorrhage: a cooperative study in Europe, Australia, and New Zealand. J Neurosurg 1996, 84:221–228.PubMedCrossRefGoogle Scholar
  16. 16.
    Haley EC, Kassell N, Apperson-Hansen C, et al.: A randomized, double-blind, vehicle-controlled trial of tirilazad mesylate in patients with aneurysmal subarachnoid hemorrhage: a cooperative study in North America. J Neurosurg 1997, 86:467–474.PubMedGoogle Scholar
  17. 17.
    Findlay JM, Kassell NF, Weir BKA, et al.: A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm. Neurosurgery 1995, 37:168–176.PubMedCrossRefGoogle Scholar
  18. 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
  19. 19.
    Juvela S: Aspirin and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Neurosurg 1995, 82:786–790.CrossRefGoogle Scholar
  20. 20.
    Higashida RT, Smith W, Gress D, et al.: Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. J Neurosurg 1997, 87:944–949.PubMedGoogle Scholar

Copyright information

© Current Science Inc 1999

Authors and Affiliations

  • Kelly D. Flemming
    • 1
  • Robert D. BrownJr.
    • 1
  • David O. Wiebers
    • 1
  1. 1.Mayo ClinicRochesterUSA

Personalised recommendations