Critical Care Management of Subarachnoid Hemorrhage
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Spontaneous aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality, and is a significant cause of morbidity including permanent functional deficit.
A thorough clinical assessment including WFNS grading and computed tomography is vital when SAH is suspected.
All confirmed cases should be referred to a specialist neurosurgical center early.
Critical-care management should aim to maintain CPP and prevent rapid changes in transmural pressure (TMP) across the aneurysm wall.
Nimodipine should be commenced in all cases of aneursymal SAH.
Delayed ischemic deficits (DID) and re-bleeding are the most frequent complications.
Occlusion of the aneurysm is achieved through endovascular coiling or surgical clipping.
Triple-H therapy is the mainstay of treatment for DID after aneurysm occlusion.
Magnesium sulfate and statin therapy show promise for DID reduction, but more research is needed.
KeywordsCerebral Vasospasm Aneurysm Wall Poor Grade Endovascular Coiling Neurogenic Pulmonary Edema
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