Physical Induced HypertensionImproves CBF (possibly more in areas of vasospasm) with associated clinical improvementNoradrenaline safe and usually first line - no risk of increased vasospasmNo evidence of new rupture riskNo clear BP target or duration:Evidence...
Defined as neurological deterioration related to ischaemia (unrelated to treatment of the aneurysm) that persists for one hour and has no other cause The clinical syndrome is of focal neurologic deficits Approximately 25% of patients develop clinical evidence of...
Seizures 6-18% Re-bleeding<72 hours5-10% HydrocephalusDay 1-320-30% Vasospasm & Delayed Cerebral IschaemiaDay 4-1470% Systemic Conditions May indicate a re-bleed and should be treated aggressively Perform an EEG in patients with neurological deterioration or...
Neurological Vasospasm and cerebral ischaemiaHydrocephalusRe-bleedingSeizuresCerebral oedema and raised ICPFocal neurology due to haemorrhage Systemic Metabolic FeverHyperglycemiaDisorders of sodium balance (50-60%):Syndrome of inappropriate antidiuretic hormone...
The largest trial comparing surgical and endovascular management of ruptured aneurysms is the ISAT trial: RCT: ISATMolyneux et alLancet (2002)View Paper Intervention Endovascular coiling vs. surgical clipping for acute ruptured intracranial aneurysm Population 2143...
