Aneurysmal Subarachnoid Hemorrhage: Unanswered Questions

Neurosurg Clin N Am. 2018 Apr;29(2):255-262. doi: 10.1016/j.nec.2018.01.001.

Abstract

Optimizing outcomes after aneurysmal subarachnoid hemorrhage remains a challenge for neurosurgeons and neurointensivists alike. Although we have learned a lot about the pathophysiology of this disease, many clinical questions are still unanswered. In this review, the authors discuss some of these questions, including the current diagnostic value of lumbar puncture in patients with negative computed tomography scans, the treatment value of blood pressure reduction and antifibrinolytics for prevention of early rebleeding, the indication for antiseizure medications, the optimal management of hydrocephalus and intracranial pressure, the role of clipping, and the options for diagnosis and treatment of delayed cerebral ischemia.

Keywords: Aneurysm; Delayed cerebral ischemia; Hydrocephalus; Subarachnoid hemorrhage; Vasospasm.

Publication types

  • Review

MeSH terms

  • Animals
  • Antifibrinolytic Agents / therapeutic use*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / therapy*
  • Humans
  • Hydrocephalus / diagnosis
  • Hydrocephalus / prevention & control
  • Hydrocephalus / therapy*
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / prevention & control
  • Intracranial Aneurysm / therapy*
  • Intracranial Pressure / drug effects
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / prevention & control
  • Subarachnoid Hemorrhage / therapy*

Substances

  • Antifibrinolytic Agents