CURRENT MANAGEMENT OF ANEURYSMAL SUBARACHNOID HEMORRHAGE GUIDELINES FROM THE CANADIAN-NEUROSURGICAL-SOCIETY

Published medical evidence pertaining to the management of aneurysmal subarachnoid hemorrhage (SAH) was critically reviewed in order to prep are practice guidelines for this condition. SAH should be considered a s a possible cause of all sudden and/or unusual headaches, and every a ttempt should be made to recognize mild SAHs, as they are still freque ntly misdiagnosed, The first test for SAH is computed tomography (CT), followed by lumbar puncture when the CT is negative for intracranial bleeding (the case in only several per cent of patients within 24 hour s of aneurysm bleeding). Urgent cerebral angiography is necessary to d etect the underlying cerebral aneurysm. The advantage of rapid diagnos is of SAH followed by early aneurysm repair is minimizing the risk of catastrophic aneurysm rebleeding, Early surgery for aneurysm repair is often possible and is recommended, unless the aneurysm location or si ze renders it technically difficult to expose in clot-laden subarachno id cisterns beneath an acutely swollen brain. Aneurysm ablation is opt imally accomplished with open microsurgery and clipping of the aneurys m neck, although other options include proximal parent artery occlusio n, ''trapping'' of the aneurysmal segment of the artery, and embolizat ion of thrombogenic materials (e.g., platinum ''microcoils'') directly into the aneurysm dome using endovascular techniques. Neurological ou tcome following SAH is also optimized through the prevention of second ary SAH complications, and further management specific for ruptured ce rebral aneurysms can include anticonvulsants, neuroprotectants, and va rious agents and techniques to prevent or reverse delayed-onset cerebr al vasospasm. All patients with aneurysmal SAH should be treated with the calcium antagonist nimodipine, and in certain circumstances patien ts should receive anticonvulsants. Induced arterial hypertension, hype rvolemia and in some instances percutaneous balloon angioplasty are re commended to reverse vasospasm causing symptomatic cerebral ischemia p rior to cerebral infarction.