Presentation is loading. Please wait.

Presentation is loading. Please wait.

Management of Subarachnoid Hemorrhage Gregory W Balturshot, M.D. Central Ohio Neurological Surgeons May 24, 2013.

Similar presentations


Presentation on theme: "Management of Subarachnoid Hemorrhage Gregory W Balturshot, M.D. Central Ohio Neurological Surgeons May 24, 2013."— Presentation transcript:

1 Management of Subarachnoid Hemorrhage Gregory W Balturshot, M.D. Central Ohio Neurological Surgeons May 24, 2013

2 Introduction Risk factors - hypertension, smoking, cocaine, female gender, age >50 Genetic risk factors - Moya Moya, Ehlers-Danlos, PCKD, Marfan’s, fibrimuscular dysplasia

3 Clinical Presentation 80% describe the sudden onset of worst headache on my life 20% experience ‘sentinal headache’ 2-8 weeks before SAH other symptoms include photophobia, nausea and vomiting, seizures, loss of consciousness

4 Hunt Hess Scale

5 Fisher Grade

6 Diagnosis Noncontrast CT - sensitivity 92-95% Lumbar Puncture - Xanthrochromia may take 12 hrs to appear after initial SAH. differentiates from a ‘traumatic tap’ MRI/MRA - sensitivity 55-93% for aneurysms >5mm it is 85-100% CTA - 77-100% and 85-100%. Additional information such as wall calcification, intraluminal thrombus, relationship to the clinoids

7 Gold standard is angiogram

8 Initial Critical Care Management Stablization of systemic oxygenation/hemodynamics ICP control BP control Seizure prophylaxis Prevention of aneurysm rebleeding (9- 17% within 72hrs)

9

10

11 Clip vs Coil ISAT - International subarachnoid aneurysm trial 2134 good grade patients with <10 mm aneurysms in the anterior circulation were randomized to clipping or coiling. Death and dependency @ 1 yr 23.5% vs 30.9% Rebleeding rates?

12 Clip vs Coil TEAM approach Factors include the clinical state of the patient, anatomic location, neck to dome ratio (wide neck), hematoma with mass effect

13


Download ppt "Management of Subarachnoid Hemorrhage Gregory W Balturshot, M.D. Central Ohio Neurological Surgeons May 24, 2013."

Similar presentations


Ads by Google