22 - Management of aneurysmal subarachnoid haemorrhage in the neurointensive care unit

Summary

The type of hospital and intensive care unit (ICU) to which the patient is admitted influences the outcome of patients with aneurysmal subarachnoid haemorrhage (aSAH). The most feared complication following aSAH due to aneurysm rupture is vasospasm, which is correlated to cerebral infarction. Magnesium sulfate was first used in preeclamptic pregnant women to reduce uterine smooth muscle contractions and is thought to prevent cerebral vasospasm by a similar mechanism on the smooth muscle of the cerebral vasculature. Cerebral complications of aSAH include recurrent intracranial haemorrhage, vasospasm, cerebral infarction, hydrocephalus, and intracranial hypertension and seizures. Systemic complications include derangements of water and electrolyte homeostasis, myocardial dysfunction, neurogenic pulmonary oedema, sepsis and thromboembolism. The aim of rehabilitation is to return the patient to the maximum level of independence possible by reducing the effects of disease or injury in daily life.