| Abstract: | Subarachnoid haemorrhage is an acute life-threatening neurosurgical emergency affecting all ages and causing high mortality and morbidity. The rupture of an aneurysm of an intracranial artery at a point of turbulent blood flow within the circle of Willis usually causes it. Diagnosis begins with a non-contrast CT of the head, followed by more definitive angiography. The focus after diagnosis is to minimize further neurological injury called secondary injury. Initial stabilization with an ABCDEF approach should focus on maintaining adequate cerebral oxygenation and cerebral perfusion pressure (CPP). In emergent cases, this may require intubation and mechanical ventilation. Transfer to a specialist neuroscience centre for ongoing management is the next priority. Culprit aneurysms should be secured promptly by endovascular coiling or surgical clipping. Anaesthesia for either clipping or coiling must be neuroprotective. Recognition and management of complications are best undertaken in a centre managing high volumes of these patients. Vasospasm and delayed cerebral ischaemia are common and feared complications of subarachnoid haemorrhage. All patients should be given nimodipine for prophylaxis and management of these complications. Future research into the pathophysiology of the injured brain in SAH can guide us to novel therapies. |
