Management of Poor-Grade Aneurysmal Subarachnoid Hemorrhage and Key Pearls for Achieving Favorable Outcomes: An Illustrative Case.
aneurysm
hydrocephalus
intracranial hypertension
poor-grade
sub-arachnoid hemorrhage
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
accepted:
31
12
2022
entrez:
3
2
2023
pubmed:
4
2
2023
medline:
4
2
2023
Statut:
epublish
Résumé
Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high patient mortality. Despite recent advances in management strategies, the prognosis for poor-grade aSAH remains dismal. We present a challenging case of a patient presenting with poor-grade aSAH. A 46-year-old female presented to the emergency department after losing consciousness following a sudden headache. The examination showed a dilated left pupil and a Glasgow Coma Scale of 4. Imaging revealed a ruptured anterior communicating artery (ACoM) aneurysm, after which the patient was subsequently taken to the neuro-interventional radiology suite. We showed that carefully managing blood pressure and intracranial pressure (ICP) makes it possible to achieve a favorable outcome and reduce the risk of secondary brain injury in aSAH, regardless of patient presentation. We propose maintaining blood pressure at <160 mmHg prior to intervention, after which it can be permitted to increase to 160-240 mmHg for the purpose of preventing vasospasm. Additionally, transcranial doppler (TCD) is essential to detect vasospasm due to the subtility of symptoms in patients with aSAH. Once identified, vasospasm can be successfully treated with balloon angioplasty. Finally, targeted temperature management (TTM), mannitol, hypertonic saline, and neuromuscular paralysis are essential for the postoperative management of ICP levels.
Identifiants
pubmed: 36733562
doi: 10.7759/cureus.33217
pmc: PMC9888499
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e33217Informations de copyright
Copyright © 2023, Bamimore et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Stroke. 1982 May-Jun;13(3):368-79
pubmed: 7080133
Crit Care. 2016 Jan 23;20:21
pubmed: 26801901
Neurol Clin. 2008 May;26(2):521-41, x
pubmed: 18514825
J Vasc Interv Neurol. 2009 Jan;2(1):142-6
pubmed: 22518243
Stroke. 2012 Jun;43(6):1711-37
pubmed: 22556195
Neurocrit Care. 2014 Jun;20(3):436-42
pubmed: 24026522
Am J Physiol. 1954 Oct;179(1):85-8
pubmed: 13207391
Ann Transl Med. 2021 Apr;9(7):581
pubmed: 33987279
J Neurosurg. 1990 Jul;73(1):18-36
pubmed: 2191090
Neurosurg Focus. 2017 Nov;43(5):E13
pubmed: 29088956
World Neurosurg. 2017 Sep;105:1-6
pubmed: 28549643
Int J Neurosci. 2017 Jan;127(1):51-58
pubmed: 26822716
Stroke. 2002 May;33(5):1225-32
pubmed: 11988595
Surg Neurol. 1994 Jan;41(1):65-74
pubmed: 8310390
J Vasc Interv Neurol. 2008 Oct;1(4):113-7
pubmed: 22518235
Stroke. 2002 Sep;33(9):2153-4; author reply 2153-4
pubmed: 12215578
Stroke. 1992 Feb;23(2):205-14
pubmed: 1561649