Diagnosis and initial management of subarachnoid haemorrhage

Simpsona, VM; Deshaiesa, EM

doi:10.13172/2054-1902-1-1-623

Cited by 3 publications

(4 citation statements)

References 35 publications

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“…[17] Advances in endovascular techniques are making coiling more widely applicable. [18] Majority of our subjects underwent coiling (33 patients;86.54%) and only 5 underwent clipping (13.15%). In the management of acute vasospasm in SAH patient, treatment with oral nimodipine is preferred in many hospital settings.…”

Section: Discussionmentioning

confidence: 93%

Intravenous Nimodipine in Initial Intensive Care Management of Vasospasm in Aneurysmal Subarachnoid Haemorrhage – A Review

Nr¹,

Sugunan²,

Reynold³

et al. 2021

Preprint

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Background: As known to every Neuroscientist the spontaneous subarachnoid haemorrhage is a medical condition in which bleeding occurs in subarachnoid space due to cerebrovascular disease most commonly due ruptured aneurysms. Nimodipine is a calcium channel antagonist used to treat vasospasm. When compared to oral, intravenous nimodipine shows better neurological outcome with low dose, less frequency of administration and less fluctuations of blood pressure in between doses ( as in oral ) due to availability of continuous infusion . Titrated dose Intra venous nimodipine is useful in the initial Intensive Care management of Subarachnoid haemorrhage for Vasospasm with close monitoring of blood pressure.Objective: To evaluate the clinical outcomes of intravenous Nimodipine in the management of acute ischemic vasospasm in subarachnoid hemorrhagic patients. Material and methods: The study was a prospective and observational study conducted in all inpatients with SAH having acute ischemic vasospasm in the intensive care unit using IV Nimodipine admitted the department of Neurosurgery in AIMS during a period of 1yr.Results: Evaluation of SAH occurrence in study patients (n=38) showed predominance of females (68.4%) and majority with hypertension (57.9%) as the common comorbid condition. The chance of developing SAH was high in patients who did not practice any form of exercise (60.5%). None of the patients had occurrence of adverse drug reactions while administering IV nimodipine other than hypotension which was corrected with inotropic support with close blood pressure monitoring. Out of the subjects enrolled, 37 patients showed improvement clinically and resolution of ischemic changes in CT scan . Majority of patients experienced cerebral edema. Using pair t test, it was found that the difference between the Glasgow Coma Score pre and follow up post treatment score were mild. Using pair t test, it was found that the difference between the mRS pre and follow up post treatment score were significant.Conclusion: Introduction of IV Nimodipine to the treatment strategy of SAH showed significant improvement in the clinical and radiological outcome.IV Nimodipine showed benefit in treating the condition without any life-threatening adverse events other than correctable hypotension. A significant decrease in the mRS score in majority of patients after treatment indicates the improvement in the quality of life of SAH patients. Pre and Post neurological status strengthens the evidence of improvement in our study subjects.

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Section: Discussionmentioning

confidence: 93%

Intravenous Nimodipine in Initial Intensive Care Management of Vasospasm in Aneurysmal Subarachnoid Haemorrhage – A Review

Nr¹,

Sugunan²,

Reynold³

et al. 2021

Preprint

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“…Digital subtraction angiography (DSA) remains the gold-standard study for the radiographic diagnosis and the overall treatment planning for patients with brain aneurysms. 1 Over the past two decades, DSA has become a well-established modality for the delineation of vasculature in the human body. 2 The technique usually involves injecting contrast medium into the veins and measuring over time the changing concentration of contrast medium passing through the vasculature of interest.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Digital Subtraction Angiography and Indocyanine Green Video Angiography in the Operative Management of Aneurysmal Subarachnoid Hemorrhage

Fayaz

Kareem

Wani

et al. 2022

Indian Journal of Neurosurgery

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Background Digital subtraction angiography (DSA) is a fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a “pre-contrast image” or mask from subsequent images, once the contrast medium has been introduced into a structure, hence the term “Digital subtraction angiography.” Indocyanine green video angiography (ICG-VA) is a safe and practical method of real-time delineation of microvasculature used in the surgical management of intracranial aneurysms, arteriovenous malformations, and other vascular lesions. Intraoperative ICG-VA is used as an adjunct in addition to intraoperative or postoperative DSA, and in other cases, it is used as the sole method to confirm the complete obliteration of clipped intracranial aneurysm. The only limitation of ICG-VA is the nonvisibility of vessels that are not in the operative field. Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA. Methods ICG angiography was done during the surgery and the findings of intraoperative ICG angiography were compared with postoperative DSA that was done between 6 and 12 weeks. DSA was done to see any compromise of lumen of parent vessel by clip, any residual aneurysm. Results In our study, intraoperative ICG complete aneurysm obliteration was present in all 30 (100%) patients, while in postoperative DSA complete aneurysm obliteration was diagnosed in 27 (90.0%) patients. Parent vessel patency was present in all 30 (100.0%) patients in both intraoperative ICG-VA and postoperative DSA. In intraoperative ICG distal branch patency was present in 26 (86.7%) patients, while in postoperative DSA distal branch patency was diagnosed in 27 (90.0%) patients. Conclusion We compared the intraoperative ICG finding and postoperative DSA finding and found that DSA is more sensitive than ICG in depicting residual aneurysm neck, hence reducing the risk of rupture of the aneurysm in future. Intraoperative ICG has high special resolution reflex feedback, intraoperative repositioning time is less and thus critical ischemia time is reduced. In a developing country like ours where DSA facilities are limited, ICG can be optimal investigation to delineate the vascular anatomy and confirmation of clip position thus reducing mortality.

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“…A high suspicion for SAH during the initial evaluation in the Emergency Department or by the Primary Care Physician increases the patient's chance for early intervention and reduces mortality and disability. 4 It is imperative that emergency department and primary care physicians understand how to diagnose and initially manage aneurysm SAH. Recent evidence based literature recommends non contrasted head CT scan as the initial first step in evaluation of SAH followed by LP if radiographic imaging is non-diagnostic.…”

Section: Introductionmentioning

confidence: 99%

“…A high suspicion for SAH during the initial evaluation increases the patient's chance for early intervention and reduces mortality and disability. 4…”

Section: Introductionmentioning

confidence: 99%

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2021

SVOANE

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Background: Aneurysm subarachnoid haemorrhage (SAH) is a leading cause of mortality (40% -50% of SAH), occurring in about 10 per 100,000 persons annually; 30, 000 SAH in the United States alone each year. SAH is characterized by three commonly occurring complaints: 'worst headache of my life', photophobia and meningismus. These symptoms often can be confused with bacterial and viral meningitis and migraine headaches. As a result, aneurysm SAH is initially misdiagnosed in nearly 12% of patients, a potentially lethal mistake. The rule of third dictates that one-third of the patients with SAH die before reaching the hospital, another third present with irrecoverable neurological deficits and last third make it to the treatment; half of the last third will have long term disabilities. In short, only about 16% of the patients will be left with the minimal or no permanent neurological sequelae after SAH. A high suspicion for SAH during the initial evaluation in the Emergency Department or by the Primary Care Physician increases the patient's chance for early intervention and reduces mortality and disabilityIt is imperative that emergency department and primary care physicians understand how to diagnose and initially manage aneurysm SAH.Methodology: This study included 30 patients and was conducted in SKIMS Srinagar with aneurysmal SAH who underwent clipping of intracranial aneurysm after taking written informed consent. A detailed history was taken. The age, gender, Glasgow Coma Scale (GCS), World Federation of Neurological Surgeons (WFNS) grade, Hunter and Hess (H -H) grade were recorded after adequate resuscitation and hemodynamic stabilization. Summary and Conclusion:The study included 30 patients with the mean age of 42.7 years. The number of male patients in the study was 17 (56.7%) and the number of female patients was 13 (43.3%). Sudden onset headache was commonest headache occurring in 17 (56.7%) patients followed by altered sensorium with sudden onset headache (43.3%) patients. Patients were mostly in H-H grade 2 (60%) and WFNS grade II (73.3%) with the GCS score of 14-15 (83.3%). H-H grade I-II-grade WFNS I-II and good GCS score translated in better operative outcome and survival where as H-H grade 3-4-5 and bad GCS Score translated in worst outcome.

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Diagnosis and initial management of subarachnoid haemorrhage

Cited by 3 publications

References 35 publications

Intravenous Nimodipine in Initial Intensive Care Management of Vasospasm in Aneurysmal Subarachnoid Haemorrhage – A Review

Intravenous Nimodipine in Initial Intensive Care Management of Vasospasm in Aneurysmal Subarachnoid Haemorrhage – A Review

Comparison between Digital Subtraction Angiography and Indocyanine Green Video Angiography in the Operative Management of Aneurysmal Subarachnoid Hemorrhage

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