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. 2015 Jan;41(1):123-6.
doi: 10.1007/s00134-014-3548-5. Epub 2014 Nov 18.

What's new in subarachnoid hemorrhage

M Smith  1 , G Citerio
Affiliations

What's new in subarachnoid hemorrhage

M Smith et al. Intensive Care Med. 2015 Jan.
No abstract available

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Figures

Fig. 1
Fig. 1
Monitoring-guided management of delayed cerebral ischemia after subarachnoid haemorrhage. The figure shows a practical approach to monitoring-guided management of DCI after subarachnoid hemorrhage. The starting point is a frequent neurological evaluation and daily TCD, with clinically significant changes defined as new focal deficit or altered consciousness and TCD mean flow velocity >120 cm/s, increase >50 cm/s in 24 h, and/or a Lindegaard index (MCA/ICA blood flow velocity ratio) >6. If the neurological examination or TCD indicates a worsening state, a reasonable approach is to search for a potential reversible cause with a CT scan, CT angiography and perfusion CT. If angiographic vasospasm is present and CBF is reduced and/or MTT increased, a trial of stepwise-induced hypertension is recommended. If this strategy reverses DCI, close monitoring with maintenance of the higher blood pressure for 2–3 days is recommended. If hypertension alone does not reverse DCI, advanced neuromonitoring and further imaging prior to interventional radiological treatment should be considered in salvageable patients. CBF cerebral blood flow, CT computerized tomography, DCI delayed cerebral ischemia, DSA digital subtraction angiography, ICA internal carotid artery, MCA middle cerebral artery, MTT mean transmit time, ptO 2 brain tissue oxygen tension, rCBF regional cerebral blood flow, TCD transcranial Doppler ultrasonography, VS vasospasm
See this image and copyright information in PMC

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