1 / 13

Management of Subarachnoid Hemorrhage

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.

liv
Download Presentation

Management of Subarachnoid Hemorrhage

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Management of Subarachnoid Hemorrhage Gregory W Balturshot, M.D. Central Ohio Neurological Surgeons May 24, 2013

  2. Introduction • Risk factors - hypertension, smoking, cocaine, female gender, age >50 • Genetic risk factors - Moya Moya, Ehlers-Danlos, PCKD, Marfan’s, fibrimuscular dysplasia

  3. Clinical Presentation • 80% describe the sudden onset of worst headache on my life • 20% experience ‘sentinal headache’ 2-8 weeks before SAH • other symptoms include photophobia, nausea and vomiting, seizures, loss of consciousness

  4. Hunt Hess Scale

  5. Fisher Grade

  6. Diagnosis • Noncontrast CT - sensitivity 92-95% • Lumbar Puncture - Xanthrochromia may take 12 hrs to appear after initial SAH. differentiates from a ‘traumatic tap’ • MRI/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

  7. Gold standard is angiogram

  8. Initial Critical Care Management • Stablization of systemic oxygenation/hemodynamics • ICP control • BP control • Seizure prophylaxis • Prevention of aneurysm rebleeding (9-17% within 72hrs)

  9. Clip vs Coil • ISAT - International subarachnoid aneurysm trial • 2134 good grade patients with <10 mm aneurysms in the anterior circulation were randomized to clipping or coiling. • Death and dependency @ 1 yr 23.5% vs 30.9% • Rebleeding rates?

  10. Clip vs Coil • TEAM approach • Factors include the clinical state of the patient, anatomic location, neck to dome ratio (wide neck), hematoma with mass effect

More Related