Medical Management of Subarachnoid Hemorrhage

Acute Stroke ◽  
2006 ◽  
pp. 113-124
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Medical Management

Blister Aneurysm of the Internal Carotid Artery

2019 ◽  
pp. 5-13
Author(s):  
Peter Nakaji ◽  
Michael R. Levitt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Internal Carotid ◽  
Conventional Imaging ◽  
Catheter Angiography ◽  
Intraoperative Rupture ◽  
Open Management

Abstract: Blister aneurysms are a rare cause of subarachnoid hemorrhage. They are easily overlooked on conventional imaging and catheter angiography due to their small size and unusual anatomic location. Whereas the medical management of subarachnoid hemorrhage is similar to that of saccular aneurysms, the surgical management of blister aneurysms is more challenging due to their unique pathology and higher risk of intraoperative rupture. Special consideration should be made for open management such as preparation of the option of bypass or the emerging use of endovascular techniques such as flow diversion. This chapter reviews the diagnosis and medical and surgical management of blister aneurysms.

Early management of aneurysmal subarachnoid hemorrhage

1981 ◽  
Vol 54 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Harold P. Adams ◽  
Neal F. Kassell ◽  
James C. Torner ◽  
Donald W. Nibbelink ◽  
Adolph L. Sahs
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Medical Management ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Early Management ◽  
Neurological Sequelae ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Effective Reduction ◽  
Fine Print

✓ The overall results are presented of early medical management and delayed operation among 249 patients studied during the period 1974 to 1977, treated within 3 days of subarachnoid hemorrhage (SAH) and evaluated 90 days after aneurysm rupture. The results included 36.2% mortality, 17.9% survival with serious neurological sequelae, and 46% with a favorable outcome. Of the patients admitted in good neurological condition, 28.7% had died and only 55.7% had a favorable recovery at 90 days after SAH. These figures represent the results despite effective reduction in early rebleeding by antifibrinolytic therapy and successful surgery in those patients reaching operation. Further therapeutic advances are needed for patients hospitalized within a few days after SAH.

Intra-arterial vasodilators for vasospasm following aneurysmal subarachnoid hemorrhage: a meta-analysis

2017 ◽  
Vol 10 (4) ◽  
pp. 380-387 ◽  
Author(s):  
Anand Venkatraman ◽  
Ayaz M Khawaja ◽  
Sahil Gupta ◽  
Shalaka Hardas ◽  
John P Deveikis ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Patient Selection ◽  
Balloon Angioplasty ◽  
Medical Management ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Neurological Improvement ◽  
Good Outcome ◽  
Neurological Response

ObjectiveThe efficacy of intra-arterial vasodilators (IADs) for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) remains debatable. The objective of this meta-analysis was to pool estimates of angiographic and neurological response, clinical outcome, and mortality following treatment of vasospasm with IADs.MethodsWe searched PubMed, Embase, Scopus, Clinicaltrials.gov, Cochrane database, and CINAHL in December 2015 and August 2016. Studies reporting angiographic and neurological response, clinical outcome, and mortality following IAD treatment of vasospasm in 10 or more adults with aSAH were included. All established IADs were allowed. Two authors independently selected studies and abstracted the data. Mean weighted probabilities (MWP) were calculated using random effects model.ResultsInclusion criteria were met by 55 studies (n=1571). MWP for immediate angiographic response to IAD treatment was 89% (95% CI 83% to 94%), post-IAD neurological improvement 57% (95% CI 49% to 65%), good outcome 66% (95% CI 60% to 71%), and mortality was 9% (95% CI 7% to 12%). After adjusting for publication bias, MWP for mortality was 5% (95% CI 4% to 7%). When transcranial Doppler (TCD) was used along with clinical deterioration for patient selection, rates of neurological response (64%) and good outcome (72%) were better. IADs were not superior to controls (balloon angioplasty or medical management).ConclusionIAD treatment leads to a robust angiographic response and fair (but lower) rates of neurological response and good clinical outcome. Mortality was lower than the average reported in the literature. Rates of neurological response and good outcome were better when TCD was used for patient selection. Carefully designed studies are needed to compare IADs against medical management and balloon angioplasty.

Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage

2000 ◽  
Vol 92 (2) ◽  
pp. 284-290 ◽  
Author(s):  
Richard S. Polin ◽  
Volker A. Coenen ◽  
Carolyn Apperson Hansen ◽  
Peter Shin ◽  
Mustafa K. Baskaya ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Scale Score ◽  
Cerebral Vasospasm ◽  
Medical Management ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Conditional Logistic Regression ◽  
Study Drug ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Fine Print

Object. Transluminal angioplasty has become a widely used adjunct therapy to medical management of symptomatic cerebral vasospasm following subarachnoid hemorrhage (SAH). Despite anecdotal reports of universal, angiographically confirmed reversal of vasospasm and high rates of clinical improvement, no rigorous examination of the efficacy of this procedure has been conducted. In this study the authors assess the efficacy of the aforementioned procedure.Methods. Thirty-eight patients enrolled as part of the North American trial of tirilazad in aneurysmal SAH underwent transluminal angioplasty for symptomatic cerebral vasospasm. Fifty-three percent of these patients showed good recovery or moderate disability based on their 3-month Glasgow Outcome Scale score.Among the 38 patients who underwent angioplasty, the severity and type of vasospasm, use of papaverine in addition to balloon angioplasty, timing of treatment, and dose of study drug did not have an effect on the outcome. The results of their neurological examinations improved in only four of the 38 patients immediately after the procedure. A conditional logistic regression analysis was performed in which these patients were compared with individuals matched for age, sex, dose of study drug, admission neurological grade, and modified Glasgow Coma Scale score at the time of angioplasty. No effect on favorable outcomes was found for this procedure.Conclusions. Transluminal cerebral angioplasty is very effective in reversing angiographically confirmed vasospasm, and anecdotal reports of its clinical utility are numerous. However, in this report the authors conclude that its superiority to medical management for symptomatic cerebral vasospasm is questionable.

scholarly journals Large basilar perforator pseudoaneurysm: A case report

2016 ◽  
Vol 22 (6) ◽  
pp. 662-665 ◽  
Author(s):  
Vistasp J Daruwalla ◽  
Furqan H Syed ◽  
Ali H Elmokadem ◽  
Michael C Hurley ◽  
Ali Shaibani ◽  
...  
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Medical Management ◽  
Coil Embolization ◽  
Flow Diverter ◽  
High Grade

Basilar perforator aneurysms are rare and a communication between a basilar perforator and a separate pseudoaneurysm cavity is extremely rare. We describe a case presenting with high grade subarachnoid hemorrhage which on further investigation delineated a 2–3 mm dissecting basilar perforator aneurysm communicating superiorly into a contained 6 mm pseudoaneurysm cavity. This case illustrates an unusual neurovascular pathology with low potential for successful endovascular treatment such as coil embolization or intracranial flow diverter stenting. Conservative medical management remains the main stay of treatment for such poor surgical candidates.

scholarly journals Management of cerebral vasospasm in subarachnoid hemorrhage

2019 ◽  
pp. S58-S66
Author(s):  
Dewi Prahaztuti ◽  
Hanik Badriyah Hidayati ◽  
Achmad Firdaus Sani
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Adhesion Molecule ◽  
Neurological Deficit ◽  
Medical Management ◽  
Treatment Modalities ◽  
Intercellular Adhesion Molecule ◽  
Delayed Ischemic Neurological Deficit

Subarachnoid hemorrhage (SAH) has been shown to result in cerebral vasospasm at day 4 to day 14, which is the main cause of mortality and morbidity after SAH. Outcome after SAH depends on many factors, including the severity of the event, medical management, and prevention of several serious complications. The principal goal in management of vasospasm after SAH is to prevent delayed ischemic neurological deficit (DIND) by decreasing intracranial pressure (ICP), optimizing cerebral oxygen demand rate and improving cerebral blood flow (CBF). Therapeutic management has been applied to prevent or treat vasospasm, including hemodynamic therapy, and endovascular therapy. Endovascular therapies, including mechanical angioplasty and chemical angioplasty with administration of intra-arterial (IA) vasodilator, have been widely used and given a good outcome. The purpose of this article is to describe the management of vasospasm including medical management and endovascular treatment. This review will describe the treatment modalities and management strategies to treat vasospasm.Abbreviations: SAH – subarachnoid hemorrhage; aSAH – aneurysmal subarachnoid hemorrhage; TCD – transcranial Doppler; ROS – reactive oxygen species; ICAM – intercellular adhesion molecule; VCAM – vascular cell adhesion molecule; IL – interleukin; CTA – computed tomography angiography; MRA – magnetic resonance angiography; CBF – cerebral blood flow; DIND – delayed ischemic neurological deficit; RCT - randomized controlled trialsCitation: Prahaztuti D, Hidayati HB, Sani AF. Management of cerebral vasospasm in subarachnoid hemorrhage. Anaesth Pain & Intensive Care 2018;22(3 Suppl 1):S58-S66.Received: 19 Oct 2018 Reviewed: 4, 11 Nov 2018 Accepted: 12 Nov 2018

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