What's new in subarachnoid hemorrhage.

Abstract

Aneurysmal subarachnoid haemorrhage (SAH) is a devastating disease first described in the era of Hippocrates. Despite advances in treatment, 1-month case fatality remains as high as 35 %, with around one-third of survivors needing lifelong care and a further third having residual cognitive impairment that affects functional status and quality of life. The immediate and delayed effects of SAH on outcome have recently been reviewed in Intensive Care Medicine [1]. There have been advances in the treatment of this devastating condition aimed at reducing early (mainly re-bleeding) or late complications, particularly delayed cerebral ischemia (DCI). The importance of treatment in high-volume centres by a multidisciplinary team cannot be over-emphasised [2]. Endovascular coiling of intracranial aneurysms represents a major advance in the treatment of SAH and allows minimally invasive and effective treatment. Flow-diverting stents, with or without coils, are an increasingly employed strategy that allows even complex aneurysm to be treated minimally invasively [3]. Clipping of the aneurysm remains an option in the minority of cases that cannot be secured via the endovascular route. Early aneurysm control reduces the risk of re-bleeding and allows maintenance of higher systemic blood pressure to prevent or treat cerebral hypoperfusion. Once the aneurysm is secured, the intensive care management of SAH involves optimization of systemic physiology, and prevention or treatment of DCI and non-neurological complications. Consensus guidelines on the critical care management of SAH have recently been published [2].