Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) is commonly caused by rupture of an intracranial aneurysm, arteriovenous malformation, or due to trauma. Prompt diagnosis and intervention are required to control intracranial pressure, maintain cerebral perfusion, and prevent rebleeding. Clinical grading of the bleed predicts morbidity and mortality, whereas imaging grading predicts risk of cerebral vasospasm. Hydrocephalus can occur as a result of SAH, which requires treatment with an external ventricular drain. Endovascular and open microsurgical procedures are available for securing the vascular abnormalities. Patients are typically monitored in a neurocritical care unit for up to 21 days post-bleed to monitor for the development of cerebral vasospasm/delayed cerebral ischemia (DCI). Mainstay of treatment for DCI includes induced hypertension, balloon angioplasty, and intraarterial vasodilator therapy. In addition, patient may experience significant derangement in their cardiac, pulmonary, and endocrine systems, requiring inotropic support, mechanical ventilation, or insulin infusion therapy.