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Lancet (London, England) Sep 2022Subarachnoid haemorrhage (SAH) is the third most common subtype of stroke. Incidence has decreased over past decades, possibly in part related to lifestyle changes such... (Review)
Review
Subarachnoid haemorrhage (SAH) is the third most common subtype of stroke. Incidence has decreased over past decades, possibly in part related to lifestyle changes such as smoking cessation and management of hypertension. Approximately a quarter of patients with SAH die before hospital admission; overall outcomes are improved in those admitted to hospital, but with elevated risk of long-term neuropsychiatric sequelae such as depression. The disease continues to have a major public health impact as the mean age of onset is in the mid-fifties, leading to many years of reduced quality of life. The clinical presentation varies, but severe, sudden onset of headache is the most common symptom, variably associated with meningismus, transient or prolonged unconsciousness, and focal neurological deficits including cranial nerve palsies and paresis. Diagnosis is made by CT scan of the head possibly followed by lumbar puncture. Aneurysms are commonly the underlying vascular cause of spontaneous SAH and are diagnosed by angiography. Emergent therapeutic interventions are focused on decreasing the risk of rebleeding (ie, preventing hypertension and correcting coagulopathies) and, most crucially, early aneurysm treatment using coil embolisation or clipping. Management of the disease is best delivered in specialised intensive care units and high-volume centres by a multidisciplinary team. Increasingly, early brain injury presenting as global cerebral oedema is recognised as a potential treatment target but, currently, disease management is largely focused on addressing secondary complications such as hydrocephalus, delayed cerebral ischaemia related to microvascular dysfunction and large vessel vasospasm, and medical complications such as stunned myocardium and hospital acquired infections.
Topics: Brain Ischemia; Humans; Hypertension; Intracranial Aneurysm; Quality of Life; Subarachnoid Hemorrhage
PubMed: 35985353
DOI: 10.1016/S0140-6736(22)00938-2 -
Cerebrovascular Diseases (Basel,... 2013Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in... (Review)
Review
BACKGROUND
Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50-60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm.
METHODS
We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines.
RESULTS
These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms.
CONCLUSION
Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.
Topics: Aneurysm, Ruptured; Consensus; Evidence-Based Medicine; Humans; Incidence; Intracranial Aneurysm; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Subarachnoid Hemorrhage
PubMed: 23406828
DOI: 10.1159/000346087 -
Neurologia (Barcelona, Spain) 2014To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment.
OBJECTIVE
To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment.
MATERIAL AND METHODS
A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed.
RESULTS
The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm.
CONCLUSIONS
SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.
Topics: Brain Ischemia; Cerebral Angiography; Humans; Intracranial Aneurysm; Magnetic Resonance Imaging; Nimodipine; Practice Guidelines as Topic; Risk Factors; Spinal Puncture; Subarachnoid Hemorrhage; Tomography, X-Ray Computed
PubMed: 23044408
DOI: 10.1016/j.nrl.2012.07.009 -
Nature Communications Feb 2024Aneurysmal subarachnoid haemorrhage (aSAH) presents a challenge to clinicians because of its multisystem effects. Advancements in computed tomography (CT), endovascular... (Review)
Review
Aneurysmal subarachnoid haemorrhage (aSAH) presents a challenge to clinicians because of its multisystem effects. Advancements in computed tomography (CT), endovascular treatments, and neurocritical care have contributed to declining mortality rates. The critical care of aSAH prioritises cerebral perfusion, early aneurysm securement, and the prevention of secondary brain injury and systemic complications. Early interventions to mitigate cardiopulmonary complications, dyselectrolytemia and treatment of culprit aneurysm require a multidisciplinary approach. Standardised neurological assessments, transcranial doppler (TCD), and advanced imaging, along with hypertensive and invasive therapies, are vital in reducing delayed cerebral ischemia and poor outcomes. Health care disparities, particularly in the resource allocation for SAH treatment, affect outcomes significantly, with telemedicine and novel technologies proposed to address this health inequalities. This article underscores the necessity for comprehensive multidisciplinary care and the urgent need for large-scale studies to validate standardised treatment protocols for improved SAH outcomes.
Topics: Humans; Subarachnoid Hemorrhage; Brain Ischemia; Cerebral Infarction; Hypertension; Aneurysm
PubMed: 38424037
DOI: 10.1038/s41467-024-46015-2 -
Ugeskrift For Laeger Jul 2019The purpose of this review is to increase the knowledge about diagnosis and treatment of aneurysmal subarachnoid haemorrhage (aSAH), which is an infrequent and critical... (Review)
Review
The purpose of this review is to increase the knowledge about diagnosis and treatment of aneurysmal subarachnoid haemorrhage (aSAH), which is an infrequent and critical condition with a high risk of severe morbidity and mortality. The outcome is improved by correct and efficient diagnosis and early treatment, including aneurysm repair. General practitioners and doctors in the departments for emergency medicine should be aware of the symptoms of aSAH.
Topics: Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage
PubMed: 31368433
DOI: No ID Found -
Practical Neurology Oct 2023Atraumatic convexity subarachnoid haemorrhage describes spontaneous bleeding into the convexities of the brain sulci without parenchymal involvement. Its many causes... (Review)
Review
Atraumatic convexity subarachnoid haemorrhage describes spontaneous bleeding into the convexities of the brain sulci without parenchymal involvement. Its many causes include reversible cerebral vasoconstriction syndrome, cerebral sinus venous thrombosis, posterior reversible encephalopathy syndrome and (in older people) cerebral amyloid angiopathy. We describe the clinical and radiological features of non-traumatic convexity subarachnoid haemorrhage with its various presentations, causes, treatments and prognoses, and use clinical vignettes to highlight important clinical points and pitfalls.
Topics: Humans; Aged; Subarachnoid Hemorrhage; Posterior Leukoencephalopathy Syndrome; Cerebrovascular Disorders; Cerebral Amyloid Angiopathy; Brain; Magnetic Resonance Imaging
PubMed: 37116951
DOI: 10.1136/pn-2022-003572 -
Aging Feb 2019
Topics: Adult; Humans; Middle Aged; Subarachnoid Hemorrhage; rhoA GTP-Binding Protein
PubMed: 30738413
DOI: 10.18632/aging.101819 -
Ugeskrift For Laeger Nov 2022New onset of seizures in children presenting with status epilepticus (SE) are rarely caused by intracranial aneurysms and haemorrhage, and the diagnosis is therefore...
New onset of seizures in children presenting with status epilepticus (SE) are rarely caused by intracranial aneurysms and haemorrhage, and the diagnosis is therefore challenging. This case report presents a ten-year-old healthy girl presenting with SE preceded by headache for two weeks. A CT-scan showed a subarachnoidal haemorrhage from a cerebral aneurysm. Intracranial pathology should be considered a differential diagnosis when receiving a child with new onset of seizures and SE. Early neuroimaging should be performed for correct treatment to be initiated without delay.
Topics: Child; Female; Humans; Subarachnoid Hemorrhage; Intracranial Aneurysm; Status Epilepticus; Headache; Seizures
PubMed: 36426817
DOI: No ID Found -
Balkan Medical Journal Mar 2023Aneurysmal subarachnoid hemorrhage is a life-threatening, neurological emergency characterized by accumulation of blood in the subarachnoid space due to a ruptured... (Review)
Review
Aneurysmal subarachnoid hemorrhage is a life-threatening, neurological emergency characterized by accumulation of blood in the subarachnoid space due to a ruptured aneurysm. Over the past several decades, improvements in the clinical management of aneurysmal subarachnoid hemorrhage have led to better patient outcomes. However, aneurysmal subarachnoid hemorrhage is still associated with high morbidity and mortality. During the acute phase of aneurysmal subarachnoid hemorrhage and prior to the definitive management of the aneurysm, numerous medical emergencies, such as elevated intracranial pressure and cerebral vasospasm, must be effectively managed to ensure the best possible neurological outcome. Early and rapid open communication between the clinical specialties caring for the aneurysmal subarachnoid hemorrhage patient is vital for rapid data collection, decision-making, and definitive treatment. In this narrative review, we aim to present the current guidelines for the multidisciplinary acute management of aneurysmal subarachnoid hemorrhage.
Topics: Humans; Subarachnoid Hemorrhage; Patient Care Team
PubMed: 36883719
DOI: 10.4274/balkanmedj.galenos.2023.2023-1-100 -
Journal of Neurology, Neurosurgery, and... Aug 2002
Topics: Coffee; Humans; Intracranial Aneurysm; Risk Factors; Subarachnoid Hemorrhage
PubMed: 12122164
DOI: 10.1136/jnnp.73.2.112