11 Critical Care Management of Subarachnoid Hemorrhage and Vasospasm

Sarah Merrill and Ayan Sen

Abstract

Subarachnoid hemorrhage (SAH) is an emergent cerebrovascular event associated with significant morbidity and mortality, which usually arises from spontaneous rupture of an arterial aneurysm. Clinical presentation typically includes a sudden, “thunderclap” headache, and may also include nausea, vomiting, and syncope. Diagnosis is made by the presence of hemorrhage on computed tomography (CT) imaging, with lumbar puncture being used for confirmation of ambiguous cases. Proper critical care management, especially within the first several days post-SAH, is crucial to preventing worsening brain injury. This chapter describes monitoring, prevention, and treatment of central nervous system (CNS) complications such as seizures, hydrocephalus, rebleeding, and vasospasm/delayed cerebral ischemia. Systemic concerns including fever, hypo-/hypertension, electrolyte imbalance, hypo-/hyperglycemia, and cardiac abnormalities are also addressed. Vasospasm is a complex sequela of SAH; the prevention, detection, and current recommendations for treatment of vasospasm are discussed.

Key words

subarachnoid hemorrhage - vasospasm - critical care - aneurysm rupture - hypertension

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