Management of Subarachnoid Hemorrhage

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Management of Subarachnoid Hemorrhage. Gregory W Balturshot, M.D. Central Ohio Neurological Surgeons May 24, 2013. Introduction. Risk factors - hypertension, smoking, cocaine, female gender, age >50 Genetic risk factors - Moya Moya, Ehlers-Danlos, PCKD, Marfan’s, fibrimuscular dysplasia. - PowerPoint PPT Presentation

Text of Management of Subarachnoid Hemorrhage

Management of Subarachnoid Hemorrhage

Management of Subarachnoid HemorrhageGregory W Balturshot, M.D.Central Ohio Neurological SurgeonsMay 24, 2013Introduction Risk factors - hypertension, smoking, cocaine, female gender, age >50Genetic risk factors - Moya Moya, Ehlers-Danlos, PCKD, Marfans, fibrimuscular dysplasiaClinical Presentation 80% describe the sudden onset of worst headache on my life20% experience sentinal headache 2-8 weeks before SAH other symptoms include photophobia, nausea and vomiting, seizures, loss of consciousness

Hunt Hess Scale

Fisher Grade

DiagnosisNoncontrast CT - sensitivity 92-95%Lumbar Puncture - Xanthrochromia may take 12 hrs to appear after initial SAH. differentiates from a traumatic tapMRI/MRA - sensitivity 55-93% for aneurysms >5mm it is 85-100%CTA - 77-100% and 85-100%. Additional information such as wall calcification, intraluminal thrombus, relationship to the clinoids

Gold standard is angiogram

Initial Critical Care Management Stablization of systemic oxygenation/hemodynamicsICP control BP control Seizure prophylaxisPrevention of aneurysm rebleeding (9-17% within 72hrs)

Clip vs CoilISAT - International subarachnoid aneurysm trial2134 good grade patients with