30/1/2017 Treatmentguidelinesupdatedforaneurysmalsubarachnoidhemorrhage|AmericanHeartAssociation

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Treatmentguidelinesupdatedforaneurysmalsubarachnoidhemorrhage
May03,2012|Categories:ScientificStatements/Guidelines(news?c=860),StrokeNews(news?c=859)

StatementHighlights:
Doctorsshouldconsideranimmediatetransferforpatientswithatypeofbleedingstroketohospitalsthattreatatleast35suchcasesayear.
Thatsoneofthenewrecommendationsinupdatedguidelinesontreatinganeurysmalsubarachnoidhemorrhage.

EMBARGOEDUNTIL3pmCT/4pmET,Thursday,May3,2012
DALLAS,May3,2012Patientswhoarediagnosedintheemergencyroomwithaspecifictypeofbrainbleedshouldbeconsideredforimmediatetransfertoahospital
thattreatsatleast35casesayear,accordingtoanewscientificstatementfromtheAmericanHeartAssociation/AmericanStrokeAssociation.

TheGuidelinesfortheManagementofAneurysmalSubarachnoidHemorrhage
(http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/HemorrhagicBleeds_UCM_310940_Article.jsp)(aSAH)ispublished
onlineinStroke,anAmericanHeartAssociationJournal.Itupdatesguidelinesissuedin2009.

Admissiontohighvolumecentershasbeenassociatedwithlowerdisabilityanddeath,saidE.SanderConnolly,Jr.,M.D.,chairofstatementwritinggroup.

Researchindicates30daydeathratesweresignificantlyhigherinlowvolumefacilities:39percentinhospitalsadmittinglessthan10patientscomparedto27percent
inhospitalstreatingmorethan35patientseachyear.

Whilethereasonsforthisassociationarenotcompletelyclear,patientsadmittedtohighvolumefacilitieshaveincreasedaccesstoexperiencedcerebrovascular
surgeonsandendovascularspecialists,aswellasmultidisciplinaryneurointensivecareservices,suchasEEGmonitoringtoruleoutnonconvulsivestatusseizures,
saidConnolly,whoisalsothevicechairmanofneurologicalsurgeryatColumbiaUniversityinNewYorkandthecodirectoroftheneurosciencesintensivecareunitat
NewYorkPresbyterianHospital.

Aneurysmalsubarachnoidhemorrhageoccurswhenaweakenedbloodvessel(aneurysm
(http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/WhatYouShouldKnowAboutCerebral
Aneurysms_UCM_310103_Article.jsp))deepwithinthebrainexpandsoutlikeaballoonthenruptures,causingbleedingintothespacearoundthebrain.Itis
responsibleforabout5percentofallstrokesandaffectsmorethan30,000Americanseachyear,mostofthembetweenages40and60yearsold.

Preventionrecommendationsstillcenteroncontrollinghypertension,avoidingcigarettesmokingandavoidingexcessivealcoholconsumption.

Aneurysmscanbetreatedbyamicrosurgicalproceduretosealthedamagedportionofthebloodvesselwithaclip,oralessinvasiveprocedurefromwithinthevessel
byplacinganumberofdetachablemetalcoilswithintheaneurysm.Bothtechniqueshavebeenshowntopreventrebleedingoftheaneurysminmostcases.

Someoftheother21newrecommendationsinclude:
BetweenonsetofaSAHsymptomsandtreatmentoftheaneurysm,bloodpressureshouldbecontrolledwithanagenttobalancetheriskofstrokeand
hypertensionrelatedrebleeding,andtomaintaincerebralperfusionpressure.
Unlessthereisacompellingcontraindication,followupimagingaftercoilingormicrosurgicalclippingofananeurysmshouldbedelayed,andstrong
considerationshouldbegiventoretreatmentiftheremnantisgrowing.
Experiencedcerebrovascularsurgeonsandendovascularspecialistsshoulddetermineamultidisciplinarytreatmentapproachbasedoncharacteristicsofthe
patientandtheaneurysm.

WhilethestatementurgesphysicianstousetheseguidelinesasmerelythestartingpointfordoingeverythingpossibletoimprovetheoutcomesofpatientswithaSAH,
Connollyurgespeopletoactquicklyifsymptomsappear.

TheclassicsymptomofaSAHisasevereheadachethatdevelopssuddenly(thunderclapheadache),andisoftenaccompaniedbyvomiting,confusion,lossof
consciousnessandsometimesseizures.

MostpeopledonotrecognizewhenaSAHisoccurring,andanyonewhoexperiencestheworstheadacheofyourlife,shouldgettotheclosestERimmediately,
Connollyurged.

Statementcowritersare:AlejandroA.Rabinstein,M.D.J.RicardoCarhuapoma,M.D.ColinP.Derdeyn,M.D.JacquesDion,M.D.RandallT.Higashida,M.D.BrianL.
Hoh,M.D.CatherineJ.Kirkness,Ph.D.,R.N.AndrewM.Naidech,M.D.,MSPHChristopherS.Ogilvy,M.D.AmanB.Patel,M.D.B.GregoryThompson,M.D.andPaul
Vespa,M.D.Authordisclosuresareonthemanuscript.

Learnmoreaboutcerebralaneurysms(http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/WhatYouShouldKnowAbout
CerebralAneurysms_UCM_310103_Article.jsp)andunderstandyourrisk
(http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/UnderstandingRisk_UCM_308539_SubHomePage.jsp).

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30/1/2017 Treatmentguidelinesupdatedforaneurysmalsubarachnoidhemorrhage|AmericanHeartAssociation
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(http://www.heart.org/corporatefunding).

NR121066(Statement/Stroke/Connolly)

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