Current Status of Problems with Initial Treatment for Aneurysmal Subarachnoid Hemorrhage

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  • Miyamoto Susumu
    Department of Neurosurgery, Graduate School of Medicine, Kyoto University
  • Kataoka Hiroharu
    Department of Neurosurgery, Graduate School of Medicine, Kyoto University
  • Nakagawa Shunsuke
    Department of Neurosurgery, National Cerebral and Cardiovascular Center
  • C Takahashi Jun
    Department of Neurosurgery, National Cerebral and Cardiovascular Center
  • Takagi Yasushi
    Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School

Bibliographic Information

Other Title
  • くも膜下出血に対する初期治療の現状と問題点
Published
2019
DOI
  • 10.7887/jcns.28.542
Publisher
The Japanese Congress of Neurological Surgeons

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<p>  Subarachnoid hemorrhage (SAH) has a poor prognosis with a mortality rate of 25-50%. Because re-rupture is highly associated with mortality, a correct diagnosis must be made as soon as possible and the appropriate initial treatment must be performed. Delayed diagnosis due to failure in obtaining a computed tomography (CT) scan or missed diagnosis of SAH on CT can sometimes results in a fatal outcome. A lumbar puncture or magnetic resonance imaging is necessary to diagnose SAH even after a negative CT scan in cases wherein SAH is suspected based on symptoms. Although there is a general consensus that analgesia, sedation, and blood pressure lowering should be performed in the initial treatment of SAH, for sedation and blood pressure control protocols have not been defined. In cases with a poor-grade SAH, intracranial pressure (ICP) and cardiovascular complications should be properly managed. Placement of an external ventricular drain is recommended for acute hydrocephalus. Three-dimensional computed tomography angiography (3D-CTA) has recently been used for identifying the bleeding source. However, 3D digital subtraction angiography (3D-DSA) is more useful for the decision making between clipping and coiling.</p>

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