Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment

Abstract

Objective: To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment.

Material and methods: A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed.

Results: The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm.

Conclusions: SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.

Keywords: Aneurisma cerebral; Cerebral aneurysm; Delayed cerebral ischaemia; Diagnosis; Diagnóstico; Hemorragia subaracnoidea; Isquemia cerebral diferida; Medical treatment; Rebleeding; Resangrado; Subarachnoid haemorrhage; Tratamiento médico; Vasoespasmo; Vasospasm.