![]() PRES (posterior reversible encephalopathy syndrome).CVT (cerebral venous sinus thrombosis or cortical vein thrombosis).Younger patients (60): CAA (cerebral amyloid angiopathy).Aneurysm: Suggested by blood near the circle of Willis (e.g., blood in the basal cisterns, sylvian fissure, interhemispheric fissure, or interpeduncular fissure).Ĭauses of convexity SAH (near the cortex) common.Iatrogenic injury to cerebral vasculature.Ĭauses of SAH based on distribution of hemorrhage.Vertebral artery dissection that extends intracranially.Mycotic aneurysm (usually due to septic emboli from endocarditis most often at distal MCA or vertebrobasilar system).Primary intracerebral hemorrhage with secondary extension to the subarachnoid space.CVT (cerebral venous sinus thrombosis).RCVS (reversible cerebral vasoconstriction syndrome).Secondary SAH (tends to occur in the high cerebral convexity see section below): ( 34618758).5% are due to other vascular malformations:.10% are perimesencephalic hemorrhages.Sympathomimetic use (e.g., cocaine, amphetamine).Genetic diseases (autosomal dominant polycystic kidney disease, Ehlers-Danlos syndrome, sickle cell disease, Marfan syndrome, fibromuscular dysplasia).Personal/family history of SAH or other aneurysm.Stronger risk factors for aneurysmal SAH include:.With an average age of ~50, SAH affects younger patients more often than most other stroke types. Nontraumatic SAH causes ~3-5% of all strokes.DVT prophylaxis with sequential compression devices until the aneurysm is protected (chemical DVT prophylaxis is initially contraindicated).Follow magnesium with daily labs & replete PRN.Target normocapnia (check blood gas & trend etCO2 if intubated).If concern for ICP elevation or herniation, consider hypertonic therapy.Avoid hyponatremia (with aggressive treatment if this occurs) and hypotonic fluid.Aggressive fever management, with physical cooling if needed.Consider vEEG for comatose patients with possible seizures.Prophylactic levetiracetam for all patients initially.Once stable, add nimodipine if tolerated to prevent vasospasm (ideally 60 mg PO q4hr).Have a low threshold to start an infusion (e.g., nicardipine or clevidipine). ![]() Treat pain immediately, before starting an antihypertensive.Usually target MAP below ~110 mm (but may be personalized).Antiplatelet reversal: (DDAVP may be considered: ).Other studies in specific situations (e.g., anti-Xa level, TEG). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |