Subarachnoid hemorrhage

Abstract

Almost 20,000 patients a year die or become disabled as a result of aneurysmal SAH. Potentially, 75% of these patients may be salvaged with improved initial diagnosis and subsequent control of rebleeding and delayed ischemia. Primary care physicians should familiarize themselves with the subtle warning symptoms that may facilitate diagnosis of an aneurysm prior to a major bleed. As a result of technical advances, early aneurysmal obliteration is not only feasible but clearly indicated in patients with good clinical grades. With the threat of rebleeding eliminated, medical therapy is directed toward the prevention or amelioration of delayed ischemic events through the optimization of intravascular volume, cerebral perfusion pressure, and cerebral blood flow. Early recognition of impending delayed ischemia and aggressive persistent titration of therapy throughout the high risk period may result in significant improvements in outcome.