Aneurysmal subarachnoid hemorrhage

An overview for the practicing neurologist

Stefan A. Dupont, Eelco F M Wijdicks, Giuseppe Lanzino, Alejandro Rabinstein

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Subarachnoid hemorrhage (SAH) accounts for ∼5% of strokes, but causes high rates of morbidity and mortality and occurs at a relatively young age. The rupture of an intracranial aneurysm is the leading cause of nontraumatic SAH and will be the subject of this review. Rebleeding remains the most imminent danger until the aneurysm is secured (i.e., excluded from the cerebral circulation). Therefore, prompt aneurysm treatment is crucial to minimize this risk. Endovascular occlusion of the aneurysm with coils has been shown to be associated with better short- and long-term outcomes than surgical clipping in select patients. Yet, angiographic surveillance is necessary after endovascular treatment and retreatment with additional coiling may be required. Delayed cerebral vasospasm is the leading cause of brain damage once the aneurysm has been treated. Hemodynamic augmentation therapy remains the mainstay of medical treatment, but various agents are being tested as means to prevent or ameliorate vasospasm, including magnesium sulfate, statins, and an endothelin antagonist. Medically refractory vasospasm demands angioplasty of the affected vessel or intraarterial infusion of vasodilators. In this review, the authors provide an overview of the diagnosis and management of aneurysmal SAH with an emphasis on these main topics

Original languageEnglish (US)
Pages (from-to)545-554
Number of pages10
JournalSeminars in Neurology
Volume30
Issue number5
DOIs
StatePublished - 2010

Fingerprint

Subarachnoid Hemorrhage
Aneurysm
Cerebrovascular Circulation
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Intracranial Vasospasm
Intra Arterial Infusions
Magnesium Sulfate
Retreatment
Intracranial Aneurysm
Therapeutics
Vasodilator Agents
Angioplasty
Rupture
Hemodynamics
Stroke
Morbidity
Mortality
Neurologists
Brain

Keywords

  • cerebral aneurysm
  • delayed cerebral infarction
  • hydrocephalus
  • Subarachnoid hemorrhage
  • vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Aneurysmal subarachnoid hemorrhage : An overview for the practicing neurologist. / Dupont, Stefan A.; Wijdicks, Eelco F M; Lanzino, Giuseppe; Rabinstein, Alejandro.

In: Seminars in Neurology, Vol. 30, No. 5, 2010, p. 545-554.

Research output: Contribution to journalArticle

Dupont, Stefan A. ; Wijdicks, Eelco F M ; Lanzino, Giuseppe ; Rabinstein, Alejandro. / Aneurysmal subarachnoid hemorrhage : An overview for the practicing neurologist. In: Seminars in Neurology. 2010 ; Vol. 30, No. 5. pp. 545-554.
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