Therapy and prognosis of subarachnoid hemorrhage
1. Big picture
Subarachnoid hemorrhage (SAH) is a life-threatening emergency. The immediate therapeutic goal is not only to treat the headache, but to prevent rebleeding, secure the aneurysm, prevent vasospasm and delayed cerebral ischemia, treat hydrocephalus, and support vital functions in an intensive care/neurosurgical center.
The key exam sentence:
Every suspected aneurysmal SAH patient must be urgently transferred to a hospital with neuroradiology and neurosurgical/endovascular facilities, because the ruptured aneurysm must be localized and treated early.
The most important treatment steps are:
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Stabilize airway, breathing, circulation.
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Urgent CT/CTA/DSA diagnosis.
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Admit to ICU/stroke/neurosurgical unit.
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Secure the aneurysm by endovascular coiling or neurosurgical clipping.
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Give nimodipine to reduce delayed ischemic deficits from vasospasm.
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Treat complications: rebleeding, hydrocephalus, vasospasm, seizures, fever, hyponatremia, arrhythmias, pulmonary edema.
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