Developing an evidence-based clinical algorithm for the assessment, diagnosis and management of acute subarachnoid hemorrhage: a review of literature

Clinico-Demographic Profile and Clinical Outcome of Young Adult Patients With Aneurysmal Subarachnoid Hemorrhage Admitted in Quirino Memorial Medical Center

“…According to the majority of the literature, 80% of SAH patients experience "the worst headache of my life," making it one of the most recognizable clinical presentations in medicine. [11].Meanwhile, 50% of patients experience syncope, a condition that could be caused by a sudden increase in intracranial pressure (ICP), which is greater than the mean artery pressure (MAP), leading to critically low cerebral perfusion pressure (CPP) and widespread cerebral ischemia [9].Based on the table, about 19.4% of the patients have experienced a loss of consciousness or syncope. Other chief complaints from the patients include headache (61.3%), a decrease in sensorium (9.7%), focal weakness and nape pain.…”

“…Sensitivity is nearly 100% for the first three days, then gradually declines over the following few days as the subarachnoid blood clears due to spontaneous lysis. [11]. If non-contrast head CT is not definitive, the next recommended diagnostic tool is the LP [7].…”

“…Another fivegrade scale that is frequently used in clinical practice is the World Federation of Neurological Surgeons scale, which has taken the position of the Hunt and Hess scale at many institutions. The prognosis is worsened by other variables, such as advanced age, a pre-existing illness, hyperglycemia, sepsis, fever, delayed cerebral ischemia (DCI), and rebleeding [11].…”

“…Then attention turns to the institution of general supportive and neuroprotective measures, in anticipation of the known complications of SAH [9]. Within 3 hours and almost half within 6 hours of the start of symptoms, rebleeding occurs, and early rebleeding is linked to worse outcomes than later rebleeding [11]. To lower the rate of rebleeding after aSAH, surgical clipping or endovascular coiling of the burst aneurysm should be carried out as soon as is feasible in the majority of patients [4].…”

“…DCI most frequently occurs 7-10 days after aneurysm rupture and resolves on its own after 21 days. Oral Nimodipine 60 mg given every 4 hours after 21 days of SAH demonstrated a significant decrease in both the incidence of cerebral infarction and poor neurological outcomes at 3-months post-SAH in the British Aneurysm Nimodipine Trial, which is the biggest research on this medication [11]. Upon the discovery of DCI, Triple-H treatment may be started.…”