Guidelines for the Management of Aneurysmal SAH课件.pptVIP

Guidelines for the Management of Aneurysmal SAH Wang Cun-zu, PhD, MD The Department of Neurosurgery, The Affiliated Hospital of Jiangsu University What Is An Aneurysm? A cerebral aneurysm is a bubble like outpouching from an artery which predisposes its carrier to cerebral hemorrhage and stroke Prevention of SAH Hypertension The relationship between hypertension and aneurysmal SAH is uncertain. However, treatment of high blood pressure with antihypertensive medication is recommended to prevent ischemic stroke, intracerebral hemorrhage, and cardiac, renal, and other end-organ injury (Class I, Level of Evidence A). Smoking Cessation of smoking is reasonable to reduce the risk of SAH, although evidence for this association is indirect (Class IIa, Level of Evidence B). Screening Screening of certain high-risk populations for unruptured aneurysms is of uncertain value (Class IIb, Level of Evidence B); advances in noninvasive imaging may be used for screening, but catheter angiography remains the gold standard when it is clinically imperative to know if an aneurysm exists. Natural History and Outcome of Aneurysmal SAH The severity of the initial bleed The severity of the initial bleed should be determined rapidly because it is the most useful indicator of outcome after aneurysmal SAH, and grading scales that rely heavily on this factor are helpful in planning future care with family and other physicians (Class I, Level of Evidence B). Risk of rebleeding of untreated, ruptured aneurysms Case review and prospective cohorts have shown that for untreated, ruptured aneurysms, there is at least a 3% to 4% risk of rebleeding in the first 24 hours—and possibly significantly higher—with a high percentage occurring immediately (within 2 to 12 hours) after the initial ictus, a 1% per day to 2% per day risk in the first month, and a long-term risk of 3% per year after 3 months. Urgent evaluation and treatment of patients with suspected SAH are therefore recommended (Class I, Le