Subarachnoid Hemorrhage: Current Perspectives Of Management

Somnath Jena*, Shakir Husain**

Abstract

Spontaneous sub-arachnoid hemorrhage (SAH), a commonly encountered emergency in neuro-critical care practice, often results from aneurysmal rupture. Other rare causes of SAH include rupture of arteriovenous malformation (AVM) and dural arteriovenous fistula (DAVF) . Presentation of SAH ranges from headache to global neurological deficits. The diagnosis of SAH is based on presence of sub-arachnoid blood on plain Computed Tomography (CT) scan. Fischer CT grade comprises of an important radiological parameter in predicting vasospasm. In circumstances of CT negative SAH the diagnosis is based on cerebral digital subtraction angiography (DSA), CT Angiography or Magnetic Resonance (MR) Angiography. Angio-negative SAH are confirmed by lumbar puncture and interval DSA. Prevention of rebleed forms the basis of treatment for ruptured aneurysms. This is achieved by endo-vascular coiling, flow diversion or customized web devices; or by surgical clipping. The outcome of SAH patients is based on time tested Hunt and Hess grade; and WFNS grade. The complications that follow SAH include vasospasm, hydrocephalus and electrolyte imbalance. Prompt recognition and management of these complications further determine the outcome of these patients. In spite of modern advances in diagnosing and managing SAH, it still remains a challenge in neuro-critical practice

Keywords: SAH, AVM, DAVF, Hunt and Hess, WFNS, CT, Fischer grade, cerebral DSA, coiling, vasospasm, flow diverter.

* Fellow Interventional Neurology and Stroke, Max Superspeciality Hospital, Delhi, India
** Senior Consultant,  Interventional Neurology and Stroke, Max Superspeciality Hospital, Delhi, India