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==Overview==
==Overview==
Primary prevention of subarachnoid hemorrhage is mainly aimed at treatment and modifcation of risk factors which are directly associated with increased occurrence of subarachnoid hemorrhage and noninvasive screening of patients with familial aSAH and/or patients with history of [[Autosomal dominant polycystic kidney disease|Autosomal dominant polycystic kidney disease (ADPKD)]].<ref name=aSAH>Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839 </ref><ref name=Etminan>Etminan N, Beseoglu K, Steiger HJ, Ha ̈nggi D. The impact of hyper- tension and nicotine on the size of ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry. 2011;82:4–7.</ref><ref name=Clarke>Clarke M. Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology. 2008;50:653– 664.</ref><ref name=Feigin>Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, Anderson CS. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005;36: 2773–2780.</ref><ref name=Lovelock>Lovelock CE, Rinkel GJ, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic
review. Neurology. 2010;74:1494–1501.</ref>


==Primary Prevention==
==Primary Prevention==
 
Effective measures for primary prevention of subarachnoid hemorrhage include:<ref name=aSAH>Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839 </ref><ref name=Etminan>Etminan N, Beseoglu K, Steiger HJ, Ha ̈nggi D. The impact of hyper- tension and nicotine on the size of ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry. 2011;82:4–7.</ref><ref name=Clarke>Clarke M. Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology. 2008;50:653– 664.</ref><ref name=Feigin>Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, Anderson CS. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005;36: 2773–2780.</ref><ref name=Lovelock>Lovelock CE, Rinkel GJ, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic
review. Neurology. 2010;74:1494–1501.</ref>
*Treatment of [[hypertension]]
*Life style modifications such as:
**Increased physical activity in obese or over weight patients to maintain healthy weight
**Reduced intake of [[sodium]] and increased intake of [[potassium]]
**A diet that is rich in fruits and vegetables
**Smoking cessation and decreased alcohal intake
**Referral to an appropriate therapeutic program is reasonable for patients who abuse drugs
*Noninvasive screening of patients with familial aSAH and/or patients with history of [[Autosomal dominant polycystic kidney disease|Autosomal dominant polycystic kidney disease (ADPKD)]]
*Prevent head [[trauma]]
*Prevent head [[trauma]]
*Identify and treat cerebral [[arteriovenous malformation]] or cerebral [[aneurysm]]
*Identify and treat cerebral [[arteriovenous malformation]] or cerebral [[aneurysm]]




 
==2012 AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage<ref name=aSAH>Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839 </ref>==
===Risk Factors for and Prevention of aSAH: Recommendations===
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[[Category:Neurotrauma]]
 
[[Category:Neurosurgery]]
[[Category:Intensive care medicine]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Cardiology]]
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Latest revision as of 18:38, 13 December 2016

Subarachnoid Hemorrhage Microchapters

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Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Subarachnoid Hemorrhage from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012)

Risk Factors/Prevention
Natural History/Outcome
Clinical Manifestations/Diagnosis
Medical Measures to Prevent Rebleeding
Surgical and Endovascular Methods
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Cerebral Vasospasm and DCI
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Primary prevention of subarachnoid hemorrhage is mainly aimed at treatment and modifcation of risk factors which are directly associated with increased occurrence of subarachnoid hemorrhage and noninvasive screening of patients with familial aSAH and/or patients with history of Autosomal dominant polycystic kidney disease (ADPKD).[1][2][3][4][5]

Primary Prevention

Effective measures for primary prevention of subarachnoid hemorrhage include:[1][2][3][4][5]

  • Treatment of hypertension
  • Life style modifications such as:
    • Increased physical activity in obese or over weight patients to maintain healthy weight
    • Reduced intake of sodium and increased intake of potassium
    • A diet that is rich in fruits and vegetables
    • Smoking cessation and decreased alcohal intake
    • Referral to an appropriate therapeutic program is reasonable for patients who abuse drugs
  • Noninvasive screening of patients with familial aSAH and/or patients with history of Autosomal dominant polycystic kidney disease (ADPKD)
  • Prevent head trauma
  • Identify and treat cerebral arteriovenous malformation or cerebral aneurysm


2012 AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage[1]

Risk Factors for and Prevention of aSAH: Recommendations

Class I
"1. Treatment of high blood pressure with antihypertensive medication is recommended to prevent ischemic stroke, intracerebral hemorrhage, and cardiac, renal, and other end-organ injury (Level of Evidence: A)"
"2. Hypertension should be treated, and such treatment may reduce the risk of aSAH (Level of Evidence: B)"
"3. Tobacco use and alcohol misuse should be avoided to reduce the risk of aSAH (Level of Evidence: B)"
"4. After any aneurysm repair, immediate cerebrovascular imaging is generally recommended to identify remnants or recurrence of the aneurysm that may require treatment (Level of Evidence: B)"
Class IIb
"1. In addition to the size and location of the aneurysm and the patient’s age and health status, it might be reasonable to consider morphological and hemody- namic characteristics of the aneurysm when discuss- ing the risk of aneurysm rupture (Level of Evidence: B)"
"2. Consumption of a diet rich in vegetables may lower the risk of aSAH (Level of Evidence: B)"
"3. It may be reasonable to offer noninvasive screening to patients with familial (at least 1 first-degree relative) aSAH and/or a history of aSAH to evaluate for de novo aneurysms or late regrowth of a treated aneurysm, but the risks and benefits of this screening require further study (Level of Evidence: B)"

References

  1. 1.0 1.1 1.2 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839
  2. 2.0 2.1 Etminan N, Beseoglu K, Steiger HJ, Ha ̈nggi D. The impact of hyper- tension and nicotine on the size of ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry. 2011;82:4–7.
  3. 3.0 3.1 Clarke M. Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology. 2008;50:653– 664.
  4. 4.0 4.1 Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, Anderson CS. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005;36: 2773–2780.
  5. 5.0 5.1 Lovelock CE, Rinkel GJ, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology. 2010;74:1494–1501.

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