The Extracranial Consequences of Subarachnoid Hemorrhage

Hall, Allan; O’Kane, Roddy

doi:10.1016/j.wneu.2017.10.016

Cited by 38 publications

(35 citation statements)

References 102 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The evidence on some aspects of coiling that remain unclear are (1) length of follow-up after aneurysm coiling and (2) the need for intervention when recanalization of the aneurysm neck after coil impaction. 36 Endovascular intervention is a rapidly growing area. Standard coiling and balloon-assisted coiling are the indicated techniques for treatment of ruptured aneurysms.…”

Section: Securing the Aneurysm: Endovascular Coiling Versus Surgical mentioning

confidence: 99%

“…Standard therapy consists of acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs, and surface cooling. 36,69…”

Section: Fevermentioning

confidence: 99%

“…A variety of cardiac complications can occur in the setting of aSAH including dysrhythmias, ST-segment changes, elevated troponin, ventricular wall motion abnormalities, and myocardial stunning. 36 Cardiac dysfunction, with reduction in ejection fraction or regional wall motion abnormalities, is present in 20 to 30% of patients with aSAH and is mainly driven by the sympathetic nervous system. 75,76 Injury to the brain, in particular the insular cortex, leads to the triad of catecholamine release, autonomic dysfunction, and neuroinflammation.…”

Section: Cardiac Complicationsmentioning

confidence: 99%

“…29 The two main causes are cerebral salt wasting (CSW) and syndrome of inappropriate antidiuretic hormone (SIADH). 29,36 Distinguishing between them can be challenging; however, polyuria and volume depletion are usually features of CSW (although not 100% confirmatory). 29,36,77 Classically, the treatment for SIADH would be fluid restriction.…”

Section: Electrolyte Abnormalities Hyponatremiamentioning

confidence: 99%

“…29,36 Distinguishing between them can be challenging; however, polyuria and volume depletion are usually features of CSW (although not 100% confirmatory). 29,36,77 Classically, the treatment for SIADH would be fluid restriction. 77 However, in the setting of aSAH, fluid restriction can lead to hypovolemia and decreased cardiac output, which in turn can worsen DCI and, ultimately, impact outcomes.…”

Section: Electrolyte Abnormalities Hyponatremiamentioning

confidence: 99%

See 4 more Smart Citations

Contemporary Management of Aneurysmal Subarachnoid Hemorrhage: A Literature Review

Yeo

Terrett

Gupta

2019

Journal of Neuroanaesthesiology and Critical Care

View full text Add to dashboard Cite

Subarachnoid hemorrhage (SAH) results in significant morbidity and mortality, which leads to additional economic and psychological burden. Atraumatic SAH is normally secondary to a ruptured aneurysm. Diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) is usually made by computed tomography (CT) of the head: noncontrast CT identifies the hemorrhage, and CT angiography identifies the aneurysm.The management of aSAH is focused on securing the aneurysm and prevention of secondary brain injury. Definitive treatment of the aneurysm is done by endovascular coiling or surgical clipping, which should be performed as soon as possible with avoidance of hypertension and strict blood pressure management prior to aneurysm securement. Routine use of nimodipine is recommended by international guidelines as a neuroprotectant. Common neurological complications of aSAH are hydrocephalus, seizures, vasospasm, and delayed cerebral ischemia (DCI). Detection of DCI, especially in patients with poor-grade aSAH, can be challenging. In addition to clinical examination, multiple radiological modalities can be used, with digital subtraction angiography being the gold standard but CT perfusion gaining an increasingly important role. Extracranial complications including cardiac dysfunction, pulmonary edema, and electrolyte abnormalities are common, causing significant morbidity and mortality.In this review, a PubMed literature search was conducted using the terms “subarachnoid hemorrhage” and “management,” with results limited to past 5 years. Journal articles were hand-selected by the authors based on relevance, and the references were reviewed to identify additional relevant publications. Historically important publications were also included.

show abstract

Section: Securing the Aneurysm: Endovascular Coiling Versus Surgical mentioning

confidence: 99%

“…Standard therapy consists of acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs, and surface cooling. 36,69…”

Section: Fevermentioning

confidence: 99%