Early rebleeding in patients with subarachnoid haemorrhage under intensive blood pressure management

Oheda, Motoki; Inamasu, Joji; Moriya, Shigeta; Kumai, Tadashi; Kawazoe, Yushi; Nakae, Shunsuke; Kato, Yōkō; Hirose, Yuichi

doi:10.1016/j.jocn.2015.02.024

Cited by 21 publications

(11 citation statements)

References 24 publications

(41 reference statements)

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“…Rebleeding should be considered the first and most dire complication of SAH in the ED setting. More than 40% of patients with SAH in the ED have a systolic blood pressure (SBP) ≥ 185 which will increase the risk of rebleeding as a result of a ruptured aneurysmal SAH [ 32 ]. The risk of rebleeding is the highest in the first 2–12 h of insult, with rates ranging from 4 to 13.6% in the first 24 h [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rebleeding is associated with poor prognosis, increased mortality, and poor neurologic recovery in survivors [ 10 ]. Although there is no direct relationship between ED-reported SBP and rate of rebleeding, a meta-analysis reported patients with an SBP > 160 mmHg in the ED were more likely to suffer from early rebleeding than those with an SBP > 140 mmHg [ 32 ]. Therefore, prompt BP reduction and management are suggested, especially in patients with suspected unsecured aneurysms.…”

Section: Discussionmentioning

confidence: 99%

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Subarachnoid hemorrhage in the emergency department

2021

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Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Subarachnoid hemorrhage in the emergency department

2021

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“…The incidence of aneurismal re-rupture is up to 30% and it indicated significant morbidity and mortality [6,12,13]. It is also a cause for momentarily worsening of the neurological condition, even death.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm

Filipče¹,

Caparoski²

2015

Prilozi

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Vasospasm and re-bleeding after subarachnoid hemorrhage from ruptured intracranial aneurysm are devastating complication that can severely affect the outcome of the patients. We are presenting a series of total number of 224 patients treated and operated at our Department due to subarachnoid hemorrhage, out of which certain number developed vasospasm and re-bleeding. We are evaluating the effect of these complications on the outcome of the patients according to the Glasgow Outcome Scale at the day of discharge. In our experience both vasospasm and ReSAH can significantly influence the outcome of patients with subarachnoid hemorrhage from ruptured intracranial aneurysm.

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“…Regarding blood pressure management, hypotension is widely thought to be detrimental. Even lowering blood pressure to prevent rebleeding prior to aneurysm repair has not been as safe and effective as expected and induced hypertension also has little evidence to support its use [ 25 , 26 , 27 , 28 ]. The dangers of high or low blood pressure during aneurysm clipping need to be remembered based on this data.…”

Section: Aneurysm Repair In Conscious-1mentioning

confidence: 99%

Lessons from the CONSCIOUS-1 Study

Schüpper

Eagles

Neifert

et al. 2020

JCM

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After years of research on treatment of aneurysmal subarachnoid hemorrhage (aSAH), including randomized clinical trials, few treatments have been shown to be efficacious. Nevertheless, reductions in morbidity and mortality have occurred over the last decades. Reasons for the improved outcomes remain unclear. One randomized clinical trial that has been examined in detail with these questions in mind is Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1). This was a phase-2 trial testing the effect of clazosentan on angiographic vasospasm (aVSP) in patients with aSAH. Clazosentan decreased moderate to severe aVSP. There was no statistically significant effect on the extended Glasgow outcome score (GOS), although the study was not powered for this endpoint. Data from the approximately 400 patients in the study were detailed, rigorously collected and documented and were generously made available to one investigator. Post-hoc analyses were conducted which have expanded our knowledge of the management of aSAH. We review those analyses here.

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Early rebleeding in patients with subarachnoid haemorrhage under intensive blood pressure management

Cited by 21 publications

References 24 publications

Subarachnoid hemorrhage in the emergency department

Subarachnoid hemorrhage in the emergency department

The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm

Lessons from the CONSCIOUS-1 Study

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