Top Things to Know: Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage
Published: May 03, 2012
- Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency and is often misdiagnosed.
- The most common clinical symptom reported by aSAH patients is “the worst headache of my life.” Nausea and vomiting are also common accompanying symptoms.
- Patients with aSAH who present in low volume hospitals should be transferred to a high volume hospital where experienced cerebrovascular surgeons, endovascular specialists, and the multidisciplinary neurointensive care services can oversee treatment and care of this devastating stroke.
- Risk factors for aSAH include hypertension, tobacco use and alcohol abuse, the use of illegal drugs such as cocaine, female gender, a history of previous aSAH, familial aneurysms, and the presence of unruptured cerebral aneurysms – especially those that are symptomatic. Consumption of a diet rich in vegetables may lower the risk of aSAH.
- The size of the aneurysm at rupture seems to be smaller in patients with a combination of smoking and hypertension compared to those with neither of these risk factors.
- Inflammation plays an important role in the pathogenesis and growth of intracranial aneurysms.
- Non-contrast computed tomography (CT scanning) of the head is still the gold standard neuroimaging to make the diagnosis of aSAH.
- Modalities for treatment include surgical clipping, endovascular coiling or stenting.
- Some common complications of aSAH include vasospasm, hydrocephalus, fever, glucose variations, anemia, and deep vein thrombosis.
- Stressful life events, such as legal or financial problems within the month prior to the rupture, may increase the risk of aSAH.
Citation
Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, and Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012: published online before print May 3, 2012, 10.1161/STR.0b013e3182587839.
http://stroke.ahajournals.org/lookup/doi/10.1161/STR.0b013e3182587839