ICU SAQs · Neurocritical care / vascular
Delayed cerebral ischaemia after SAH — diagnosis and management
A CICM SAQ on delayed cerebral ischaemia after SAH — the consensus definition, clinical and TCD monitoring, blood pressure, and the limited evidence for induced hypertension.
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Prompt
A patient with a subarachnoid haemorrhage from a ruptured anterior communicating artery aneurysm, coiled on day 0, develops a new right-sided weakness on day 6. Describe the diagnosis and the management.
Question
A patient with a subarachnoid haemorrhage from a ruptured anterior communicating artery aneurysm, coiled on day 0, develops a new right-sided weakness on day 6. Describe the diagnosis and the management.[1]
References8ShowHide
- [1]Vergouwen MD, Vermeulen M, van Gijn J, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group Stroke, 2010.PMID 20798370
- [2]Abdulazim A, Heilig M, Rinkel G, et al. Diagnosis of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage and Triggers for Intervention. Neurocritical care, 2023.PMID 37537496
- [3]Vora YY, Suarez-Almazor M, Steinke DE, et al. Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage Neurosurgery, 1999.PMID 10371622
- [4]Gathier CS, van den Bergh WM, Slooter AJC, et al. Induced Hypertension for Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Randomized Clinical Trial Stroke, 2018.PMID 29158449
- [5]Vergouwen MDI, Ramos-Pachon A, Terecoasa EO, et al. European Stroke Organisation (ESO), European Association of Neurosurgical Societies (EANS) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on aneurysmal subarachnoid haemorrhage. European stroke journal, 2026.PMID 42095754
- [6]Gathier CS, Zijlstra IAJ, Rinkel GJE, et al. Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage J Crit Care, 2022.PMID 36208555
- [7]Dorhout Mees SM, Rinkel GJ, Feigin VL, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage Cochrane Database Syst Rev, 2007.PMID 17636626
- [8]Brathwaite S, Macdonald RL Current management of delayed cerebral ischemia: update from results of recent clinical trials Transl Stroke Res, 2014.PMID 24338266