What is the management of subarachnoid hemorrhage?
The traditional treatment of subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm included strict blood pressure control, with fluid restriction and antihypertensive therapy.
When should nimodipine be started after SAH?
Nimodipine should start as early as possible or within 96 hours of the diagnosis of subarachnoid hemorrhage. The recommended dose for adults is 60 mg (two 30-mg capsules) every 4 hours for 21 consecutive days.
Is LP contraindicated in subarachnoid hemorrhage?
LP should not be performed if the CT scan demonstrates an SAH because of the (small) risk of further intracranial bleeding associated with a drop in ICP. An LP is performed to evaluate the cerebrospinal fluid for the presence of red blood cells (RBCs) and xanthochromia.
Why is nimodipine used for SAH?
Nimodipine is used to decrease problems due to a certain type of bleeding in the brain (subarachnoid hemorrhage-SAH). Nimodipine is called a calcium channel blocker. The body naturally responds to bleeding by narrowing the blood vessel to slow blood flow.
How is BP controlled in subarachnoid hemorrhage?
To prevent aneurysmal re-rupture, hypertension requires prompt treatment. Analgesics alone may be effective; otherwise rapidly acting antihypertensives are needed. The preferred agents include labetalol, ß-blockers, hydralazine and nicardipine (51-53).
Why is nimodipine used in vasospasm?
Nimodipine is a dihydropyridine agent that blocks voltage-gated calcium channels and has a dilatory effect on arterial smooth muscle. It is the only FDA-approved agent for vasospasm with a half-life of about 9 h [6].
Can CT exclude SAH?
Conclusion: Within a tertiary referral centre for SAH, a normal head CT has a very high negative predictive value to exclude SAH when carried out within 24 hours from ictus provided a 3rd generation CT scanner is utilised, and the scan is reported by a neuroradiologist.
Can CT rule out SAH?
CT scan alone is sensitive enough to rule out subarachnoid haemorrhage in patients presenting with lone acute severe headache, normal level of consciousness, and no neurological features, if performed within 6 h of onset with a third generation CT scanner with thin slices, and reported by a radiologist experienced in …
Can amlodipine and nimodipine be taken together?
Interactions between your drugs No interactions were found between amlodipine and nimodipine.
What medication reduces ICP?
Medication Summary Carbonic anhydrase inhibitors (eg, acetazolamide) and loop diuretics (eg, furosemide) are thought to exert their effect on ICP by reducing cerebrospinal fluid (CSF) production at the choroid plexus. Cardiac glycosides have a similar effect.
Is mannitol given in subarachnoid hemorrhage?
Clinical Bottom Line There is no evidence of benefit of the administration of mannitol in patients with subarachnoid haemorrhage. However, in patients with signs of rising intracranial pressure and decreasing neurological function the benefits may be felt to outweigh the risks.
Is nimodipine given IV?
Be aware that nimodipine should be administered ONLY by the oral route or via nasogastric tube. It should NEVER be administered intravenously.
Can amlodipine and nimodipine be given together?
Is ICU management of aneurysmal subarachnoid hemorrhage appropriate?
Introduction: Aneurysmal subarachnoid hemorrhage (SAH) has very high morbidity and mortality rates. Optimal intensive care unit (ICU) management requires knowledge of the potential complications that occur in this patient population. Methods: Review of the ICU management of SAH. Level of evidence for specific recommendations is provided.
What is the prognosis of subarachnoid hemorrhage?
Subarachnoid hemorrhage is an often devastating intracranial hemorrhage resulting from acute bleeding into the subarachnoid space. Although its overall incidence is less than that of acute ischemic stroke, sub-arachnoid hemorrhage carries increased risks of both mortality and disability.
What is the role of tranexamic acid in the treatment of subarachnoid hemorrhage?
Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study. J Neurosurg. 2002 Oct;97 (4):771-8.
What is the PMID of the Alfred ICU?
PMID: 12405362. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University .