brain, spinal cord, and nerve disorders
Subarachnoid Hemorrhage (SAH)
Treatment of SAH
Medications to relieve the headache Measures to treat or prevent complications A procedure to treat aneurysms People who may have had a subarachnoid hemorrhage are hospitalized immediately. When possible, they are transported to a center that specializes in treating stroke. Bed rest with no exertion is essential. Anticoagulants (such asheparinandwarfarin) and antiplatelet medications (such asaspirin) are not given because they make the bleeding worse. Pain relievers (analgesics) such as opioids are given as needed to control the severe headaches. However,aspirinand other nonsteroidal anti-inflammatory medications are not used because they can worsen the bleeding. Stool softeners are given to prevent straining during bowel movements. Such straining puts pressure on blood vessels within the skull and increases the risk that a weakened artery will rupture. Nimodipine, a calcium channel blocker, is usually given by mouth to prevent vasospasm and subsequent ischemic stroke. Doctors take measures (such as giving medications and adjusting the amount of intravenous fluid given) to keep blood pressure at levels low enough to avoid further hemorrhage and high enough to maintain blood flow to the damaged parts of the brain. Treatment is treated only if it is very high. If hydrocephalus develops, a piece of plastic tubing (shunt) may be placed in the brain to drain cerebrospinal fluid away from the brain. This procedure treats hydrocephalus by relieving pressure. For people who have an aneurysm, a surgical procedure is done to isolate, block off, or support the walls of the weak artery and thus reduce the risk of fatal bleeding later. These procedures are difficult, and regardless of which one is used, the risk of death is high, especially for people who are in a Stupor and Coma . The best time for surgery is controversial and must be decided based on the person’s situation. If the person can be aroused, most neurosurgeons recommend operating within 24 hours of the start of symptoms, before hydrocephalus and vasospasm develop. If surgery cannot be done this quickly, the procedure may be delayed 10 days to reduce the risks of surgery, but then bleeding is more likely to recur because the waiting period is longer. One of the following surgical procedures (called endovascular surgery) is used to repair an aneurysm: Endovascular coiling Endovascular stenting Endovascular coilingis commonly used. It involves inserting coiled wires into the aneurysm. For this procedure, a catheter is inserted into an artery, usually in the groin, and threaded to the affected artery in the brain. A contrast agent is injected to enable the doctor to make the aneurysm visible on an x-ray. The catheter is then used to place the coils in the aneurysm. Thus, this procedure does not require that the skull be opened. By slowing blood flow through the aneurysm, the coils encourage the formation of blood clots, which seals off the aneurysm and prevents it from rupturing. Endovascular coils can be placed at the same time as cerebral angiography, when the aneurysm is diagnosed. The coils remain in place permanently. Inendovascular stenting,a catheter is used to place a tube made of wire (stent) across the opening of the aneurysm. The stent reroutes normal blood flow around the aneurysm, preventing blood from entering the aneurysm and eliminates the risk of rupture. The stent remains in place permanently. Less commonly, ametal clipis placed across the aneurysm. For this procedure, surgeons make an incision in the skin of the head and remove a piece of the skull so that they can see the aneurysm. The clip is then placed across the opening of the aneurysm. This procedure prevents blood from entering the aneurysm and eliminates the risk of rupture. The clip remains in place permanently. Surgical placement of a clip requires spending several nights in the hospital. Most clips that were placed 15 to 20 years ago are affected by the magnetic forces and can be displaced during magnetic resonance imaging (MRI). People who have these clips should inform their doctor if MRI is being considered. Newer clips are not affected by the magnetic forces. 