Subarachnoid hemorrhage (SAH) is a common and devastating condition.1 Each year approximately 30,000 Americans suffer from a non-traumatic SAH. Patients who have suffered a SAH are best managed in an ICU or a specialized neurological/neurosurgical unit. Despite improved management the outcome following SAH remains poor, with an overall mortality of approximately 25% and significant morbidity amongst the survivors. The most serious complications following the initial bleed are rebleeding and cerebral vasospasm; management of patients with SAH is therefore largely directed to avoiding these complications. The risk of rebleeding (with conservative therapy) is highest in the first month, with a rate of between 20 and 30%. The mortality rate is approximately 70% for patients who rebleed. Angiographic vasospasm probably develops to some degree in most patients who suffer an SAH. However, clinically manifest vasospasm occurs in approximately 40% of patients. Fifteen to twenty percent of these patients will suffer a stroke or die despite aggressive management.
KeywordsCerebral Perfusion Pressure Tranexamic Acid Cerebral Vasospasm Regional Cerebral Blood Flow Endovascular Coiling
- 1.Bederson JB, Connolly ES, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009:doi: 10.1161/STROKEAHA.108.191395.Google Scholar
- 8.Molyneux AJ, Kerr RS, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366:809–817.PubMedCrossRefGoogle Scholar