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Management of Poor-Grade Aneurysmal Subarachnoid Hemorrhage and Key Pearls for Achieving Favorable Outcomes: An Illustrative Case.

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العنوان: Management of Poor-Grade Aneurysmal Subarachnoid Hemorrhage and Key Pearls for Achieving Favorable Outcomes: An Illustrative Case.
المؤلفون: Bamimore MA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, USA., Lee SJ; Department of Neurological Surgery, Mayo Clinic, Jacksonville, USA., Perez Vega C; Department of Neurological Surgery, Mayo Clinic, Jacksonville, USA., Brown N; Department of Neurological Surgery, University of California Irvine, Orange, USA., Gendreau JL; Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, USA., Al Shaikh RH; Department of Neurological Surgery, Mayo Clinic, Jacksonville, USA., Jeevaratnam S; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, USA., Freeman WD; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, USA.
المصدر: Cureus [Cureus] 2023 Jan 01; Vol. 15 (1), pp. e33217. Date of Electronic Publication: 2023 Jan 01 (Print Publication: 2023).
نوع المنشور: Case Reports
اللغة: English
بيانات الدورية: Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: eCollection Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Palo Alto, CA : Cureus, Inc.
مستخلص: 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.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2023, Bamimore et al.)
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فهرسة مساهمة: Keywords: aneurysm; hydrocephalus; intracranial hypertension; poor-grade; sub-arachnoid hemorrhage
تواريخ الأحداث: Date Created: 20230203 Latest Revision: 20230204
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC9888499
DOI: 10.7759/cureus.33217
PMID: 36733562
قاعدة البيانات: MEDLINE
الوصف
تدمد:2168-8184
DOI:10.7759/cureus.33217