A subarachnoid hemorrhage (SAH) is the accumulation of blood between the pia mater and the arachnoid mater and is considered a neurological emergency associated with significant morbidity and mortality. Causes of SAH can include arteriovenous malformation or fistula, arterial dissection, tumor, venous thrombosis, vasculitis, and most commonly, aneurysm rupture, accounting for more than 80% of cases.1 Aneurysmal SAH (aSAH) can be viewed as a disease process with three phases occurring on a continuum—the acute phase (first 24 hours after rupture), the subacute phase (24-72 hours), and the chronic phase (day 3 -14) hallmarked by delayed cerebral ischemia (DCI) and cerebral vasospasm. Management of the acute and subacute phases focuses on the prevention of rebleeding and management of secondary complications such as hydrocephalus, seizures, and cardiopulmonary dysfunction. The management of the chronic phase focuses on the prevention of DCI with a multimodal monitoring approach using serial clinical examinations, both noninvasive and invasive monitoring strategies, and initiation of oral nimodipine.
Patel R. Management of Aneurysmal Subarachnoid Hemorrhages and Delayed Cerebral Ischemia. Lynchburg Journal of Medical Science. 2022; 4(4).
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