neurologic disorders
Subarachnoid Hemorrhage (SAH)
Treatment of Subarachnoid Hemorrhage
Treatment in a comprehensive stroke center Nicardipineif mean arterial pressure is>130 mm Hg Nimodipineto prevent vasospasm Occlusion of causative aneurysms Patients with subarachnoid hemorrhage should be treated in a comprehensive stroke center whenever possible. Bed rest is mandatory. Restlessness and headache are treated symptomatically. Stool softeners are given to prevent constipation, which can lead to straining. is titrated as for Treatment ( Anticoagulants and antiplatelet medications are contraindicated. Vasospasmis prevented by givingnimodipine60 mg orally every 4 hours for 21 days to prevent vasospasm, but BP needs to be maintained in the desirable range (usually considered to be a mean arterial pressure of 70 to 130 mm Hg and a systolic pressure of 120 to 185 mm Hg). If clinical signs of acute hydrocephalus occur, ventricular drainage should be considered. Aneurysmsare occluded to reduce risk of rebleeding. Detachable endovascular coils can be inserted during angiography to occlude the aneurysm. Alternatively, if the aneurysm is accessible, surgery to clip or stent the aneurysm can be done, especially for patients with an evacuable hematoma or acute hydrocephalus. If patients are arousable, most vascular neurosurgeons operate within the first 24 hours to minimize risk of rebleeding and risks due to angry brain. If>24 hours have elapsed, some neurosurgeons delay surgery until 10 days have passed; this approach decreases risks due to angry brain but increases risk of rebleeding and overall mortality. 1.Greenberg SM, Ziai WC, Cordonnier C, et al: 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association.Stroke53 (7):e282–e361, 2022. doi: 10.1161/STR.0000000000000407 Epub 2022 May 17. 