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Critical Care Management of Subarachnoid Hemorrhage

  • Audrey C. Quinn
  • Simon P. Holbrook
Chapter
Part of the Competency-Based Critical Care book series (CBCC)

Key Points

  1. 1.

    Spontaneous aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality, and is a significant cause of morbidity including permanent functional deficit.

     
  2. 2.

    A thorough clinical assessment including WFNS grading and computed tomography is vital when SAH is suspected.

     
  3. 3.

    All confirmed cases should be referred to a specialist neurosurgical center early.

     
  4. 4.

    Critical-care management should aim to maintain CPP and prevent rapid changes in transmural pressure (TMP) across the aneurysm wall.

     
  5. 5.

    Nimodipine should be commenced in all cases of aneursymal SAH.

     
  6. 6.

    Delayed ischemic deficits (DID) and re-bleeding are the most frequent complications.

     
  7. 7.

    Occlusion of the aneurysm is achieved through endovascular coiling or surgical clipping.

     
  8. 8.

    Triple-H therapy is the mainstay of treatment for DID after aneurysm occlusion.

     
  9. 9.

    Magnesium sulfate and statin therapy show promise for DID reduction, but more research is needed.

     

Keywords

Cerebral Vasospasm Aneurysm Wall Poor Grade Endovascular Coiling Neurogenic Pulmonary Edema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag London Limited 2010

Authors and Affiliations

  • Audrey C. Quinn
    • 1
  • Simon P. Holbrook
    • 2
  1. 1.Leeds General Infirmary Leeds Teaching Hospitals NHS TrustLeedsUK
  2. 2.Academic Unit of AnesthesiaSt. James’s University HospitalLeedsUK

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