Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Abstract

Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

“…Subjects' written informed consent was obtained according to the Declaration of Helsinki. The clinical care of SAH patients conformed to guidelines set forth by the Neurocritical Care Society, the American Heart Association/American Stroke Association and the European Stroke Organization 9, 10, 11. All patients were followed with every‐other‐day transcranial Doppler sonography (DWL Doppler‐Box system; Compumedics, Singen Germany) and received oral or intravenous nimodipine.…”

Natural course of subarachnoid hemorrhage is worse in elderly patients

“…Although the concept of elder patient varies (most developed countries consider over 65 years old and World Health Organization warrants over 60 years old), we have chosen the cutoff of 70 years old, which is the most addressed threshold in pertinent guidelines as a landmark for therapeutic decision of IA 1,2 . Inclusion criteria: all patients diagnosed with ruptured intracranial aneurysms submitted to treatment based in surgical approach and/or endovascular approach.…”

“…Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA) submitted to treatment 1,2,3,4,5 . In those patients, there is increased impairment of consciousness, thick subarachnoid clot, intraventricular hemorrhage, acute hydrocephalus and higher probability of rebleeding after subarachnoid hemorrhage (SAH) 4 .…”

Angiotensin-(1-7) Protects against the Development of Aneurysmal Subarachnoid Hemorrhage in Mice

“…1 Unruptured aneurysms are asymptomatic until they rupture. However, subarachnoid hemorrhage from aneurysmal rupture results in severe morbidity and high mortality.…”

“…However, subarachnoid hemorrhage from aneurysmal rupture results in severe morbidity and high mortality. 1 Inflammation is emerging as a key player in the processes that lead to aneurysmal rupture. [2][3][4] Therefore, the pharmacological prevention of aneurysmal rupture that targets inflammation may be an attractive approach for patients with inoperable unruptured aneurysms.…”