🧠 Aneurysmal Subarachnoid Hemorrhage (aSAH) Management
By whether the aneurysm is secured, hydrocephalus and symptomatic DCI, give nimodipine, BP control, drainage and induced-hypertension direction. Instant, browser-side.
Aneurysmal Subarachnoid Hemorrhage (aSAH) Management
Ruptured aneurysm secured (clipping/coiling)
Acute hydrocephalus / ventricular enlargement with reduced consciousness
Symptomatic vasospasm / delayed cerebral ischemia (DCI)
When to use
Management framing of aneurysmal subarachnoid hemorrhage.
How it works
Unsecured aneurysm → secure (coil/clip) early, ideally within 24 h, controlling BP with a short-acting agent beforehand. All patients → enteral nimodipine 60 mg q4h for ~21 days. Acute hydrocephalus → EVD. Symptomatic DCI → induced hypertension + normovolemia (± endovascular therapy).
Key points
- Early aneurysm securing prevents catastrophic rebleeding; avoid hypotension that harms cerebral perfusion.
- Nimodipine is the core preventive measure for delayed cerebral ischemia and improves functional outcome in all aSAH patients.
- Prophylactic hypervolemia, routine statin and IV magnesium are not recommended.
- Maintain normovolemia and electrolytes (hyponatremia common); transfer to a comprehensive stroke center / neuro-ICU.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.