Understanding the disease: aneurysmal subarachnoid hemorrhage

Excerpt

Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency after which patients are routinely admitted to an intensive care unit [1]. aSAH is characterized by rupture of an intracranial aneurysm that injects blood under arterial pressure into the subarachnoid space. Hippocrates in Aphorisms on Apoplexy probably described a case: “When persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor, they die in seven days.” This sentence fully describes aSAH, starting as a hemorrhagic disease, associated with immediate neurological and systemic complications followed by late ischemic events that can be fatal. Early rebleeding following aSAH is common, up to 10 % in the first 3 days with a worsening in prognosis. Strategies for reducing the risk of rebleeding encompass early aneurysm repair and control of extreme hypertension before securing the aneurysm. A short course of antifibrinolytic therapy limited at the period prior to early aneurysm repair and discontinued before planned endovascular ablation of an aneurysm remains an option [1]. …