Acute management of aneurysmal subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) accounts for about 5% of all strokes and affects 6– 12/ 100 000 of the UK population per year, the majority of whom are young. Mortality is around 50%, with up to 25% dying before reaching hospital. One-third of survivors are dependent for care and almost half will have cognitive impairment sufficient to affect their quality of life. 1,2 SAH requires a multi-disciplinary approach to management 3 in a neurosciences centre, 4 with treatment directed towards securing the ruptured aneurysm, minimizing secondary brain injury, and preventing and treating systemic complications. In 2011, the Neurocritical Care Society issued consensus guidelines for the critical care management of aneurysmal SAH with the aim of improving outcome. 4

[1]  B. Bendok,et al.  Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm. , 2009, Neurosurgical focus.

[2]  Giuseppe Citerio,et al.  Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference , 2011, Neurocritical care.

[3]  Jacqueline Birks,et al.  Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up , 2009, The Lancet Neurology.

[4]  Martin R. Smith,et al.  Cardiovascular complications of brain injury , 2012 .

[5]  S. Mayer,et al.  Medical complications after subarachnoid hemorrhage: new strategies for prevention and management , 2006, Current opinion in critical care.

[6]  S. Mayer,et al.  Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage , 2011, Stroke.

[7]  E. Wijdicks,et al.  Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage , 2010, The Lancet Neurology.

[8]  M. Crocker,et al.  Disturbances of sodium in critically ill adult neurologic patients: a clinical review. , 2006, Journal of neurosurgical anesthesiology.

[9]  J. Fandino,et al.  Management of aneurysmal subarachnoid haemorrhage. , 2014, Swiss medical weekly.

[10]  I. C. Schaaf,et al.  Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review , 2010, Critical care.

[11]  M. Diringer.  Management of aneurysmal subarachnoid hemorrhage , 2009, Critical care medicine.

[12]  David S. Rosen,et al.  Subarachnoid hemorrhage grading scales , 2005, Neurocritical care.

[13]  Martin R. Smith.  Intensive care management of patients with subarachnoid haemorrhage , 2007, Current opinion in anaesthesiology.

[14]  W. Poon,et al.  Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage: an updated systemic review and meta-analysis , 2011, Critical care.

[15]  J. Madigan,et al.  Investigating suspected subarachnoid haemorrhage in adults , 2011, BMJ : British Medical Journal.