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The First Week After Aneurysmal Subarachnoid Hemorrhage 

The First Week After Aneurysmal Subarachnoid Hemorrhage
The First Week After Aneurysmal Subarachnoid Hemorrhage
Neurocritical Care (2 ed.)

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate


Subarachnoid hemorrhage patients who present stuporous, comatose, or with focal neurological deficits demand immediate attention. This chapter addresses what causes neurological decline as well as early care. The causes of neurological decline in aneurysmal subarachnoid hemorrhage relate to the time from aneurysm rupture. Early care includes the management of acute hydrocephalus, ventriculostomy placement, aneurysm repair, and management of systemic complications. Induced hypertension is the most useful medical treatment to reverse ischemic symptoms. Endovascular therapy is necessary when symptoms are refractory or the patient has poor cardiopulmonary reserve and cannot tolerate hemodynamic augmentation. Despite major setbacks for some, many of these critically ill patients can achieve reasonable clinical outcomes.

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