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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
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Emergency Medical Management of Aneurysmal Subarachnoid Hemorrhage

Mervyn D I Vergouwen1, Gabriel J E Rinkel2

  • 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. M.D.I.Vergouwen@umcutrecht.nl.

Neurocritical Care
|June 21, 2023
PubMed

Aneurysmal subarachnoid hemorrhage is a medical emergency that necessitates direct transfer to a tertiary referral center specialized in the diagnosis and treatment of this condition. The initial hours after aneurysmal rupture are critical for patients with aneurysmal subarachnoid hemorrhage, both in terms of rebleeding and combating the effect of early brain injury. No good treatment options are available to reduce the risk of rebleeding before aneurysm occlusion. Lowering the blood pressure may reduce the risk of rebleeding but carries a risk of inducing delayed cerebral ischemia or aggravating the consequences of early brain injury. Early brain injury after aneurysmal rupture has an important effect on final clinical outcome. Proper cerebral perfusion is pivotal in these initial hours after aneurysmal rupture but threatened by complications such as neurogenic pulmonary edema and cardiac stunning, or by acute hydrocephalus, which may necessitate early drainage of cerebrospinal fluid.

Keywords:
AntifibrinolyticsBlood pressure hydrocephalusCerebral edemaEmergency careHyperglycemiaPulmonary edemaSeizuresSubarachnoid hemorrhageTakotsubo cardiomyopathy

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