Velázquez CA, Morales RJD, González MKI, Alonso MD, Peña PCA

Language: Spanish
References: 28
Page: 67-73
PDF size: 297.12 Kb.

ABSTRACT

Subarachnoid hemorrhage (SAH) is a neurovascular emergency; it peaks between 50 and 60 years of age and is more common in women than in men. Spontaneous rupture of an intracranial aneurysm is the most common cause of SAH and this mechanism triggers a series of pathophysiological processes that culminate in systemic involvement and organ failure. After stroke and the development of complications, multidisciplinary health care needs arise in this group of patients, which has a direct impact on functionality. That is why we consider important neuromonitoring, timely detection of complications and follow-up of patients with this pathology within the intensive care unit. We present the case of a woman with multiple risk factors for developing cerebrovascular disease. She was diagnosed with subarachnoid hemorrhage that required treatment in the intensive care unit. Neuromonitoring was directed by transcranial Doppler ultrasound. She developed early complications 48 hours after the onset of the clinical picture, with the presence of mild vasospasm despite treatment with nimodipine, in addition to the presence of rebleeding documented with magnetic resonance angiography. She required surgical treatment with apparent improvement and again presented another episode of vasospasm that required interventional treatment.

REFERENCES

1. Thilak S, Brown P, Whitehouse T, Gautam N, Lawrence E, Ahmed Z, et al. Diagnosis and management of subarachnoid haemorrhage. Nat Commun. 2024;15(1):1850. doi: 10.1038/s41467-024-46015-2

2. Maher M, Schweizer TA, Macdonald RL. Treatment of spontaneous subarachnoid hemorrhage: guidelines and gaps. Stroke. 2020;51(4):1326-1332. doi: 10.1161/STROKEAHA.119.025997

3. Leblanc R. Familial cerebral aneurysms. Can J Neurol Sci. 1997;24(3):191-199. doi: 10.1017/s031716710002179x

4. Ronkainen A, Hernesniemi J, Puranen M, Niemitukia L, Vanninen R, Ryynanen M, et al. Familial intracranial aneurysms. Lancet. 1997;349(9049):380-384. doi: 10.1016/S0140-6736(97)80009-8

5. Lauzier DC, Jayaraman K, Yuan JY, Diwan D, Vellimana AK, Osbun JW, et al. Early brain injury after subarachnoid hemorrhage: incidence and mechanisms. Stroke. 2023;54(5):1426-1440. doi: 10.1161/STROKEAHA.122.040072

6. Robba C, Goffi A, Geeraerts T, Cardim D, Via G, Czosnyka M, et al. Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review. Intensive Care Med. 2019;45(7):913-927. doi: 10.1007/s00134-019-05610-4

7. Tominari S, Morita A, Ishibashi T, Yamazaki T, Takao H, Murayama Y, et al. Prediction model for 3-year rupture risk of unruptured cerebral aneurysms in Japanese patients. Ann Neurol. 2015;77(6):1050-1059. doi: 10.1002/ana.24400

8. Lindgren AE, Koivisto T, Bjorkman J, von Und Zu Fraunberg M, Helin K, Jaaskelainen JE, et al. Irregular shape of intracranial aneurysm indicates rupture risk irrespective of size in a population-based cohort. Stroke. 2016;47(5):1219-1226. doi: 10.1161/STROKEAHA.115.012404

9. Klass A, Sánchez-Porras R, Santos E. Systematic review of the pharmacological agents that have been tested against spreading depolarizations. J Cereb Blood Flow Metab. 2018;38(7):1149-1179. doi: 10.1177/0271678X18771440

10. Cahill J, Calvert JW, Zhang JH. Mechanisms of early brain injury after subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2006;26(11):1341-1353. doi: 10.1038/sj.jcbfm.9600283

11. Danière F, Gascou G, Menjot de Champfleur N, Machi P, Leboucq N, Riquelme C, et al. Complications and follow up of subarachnoid hemorrhages. Diagn Interv Imaging. 2015;96(7-8):677-686. doi: 10.1016/j.diii.2015.05.006

12. Starke RM, Connolly ES Jr; Participants in the International Multi-Disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage. Rebleeding after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011;15(2):241-246. doi: 10.1007/s12028-011-9581-0

13. Woernle CM, Winkler KM, Burkhardt JK, Haile SR, Bellut D, Neidert MC, et al. Hydrocephalus in 389 patients with aneurysm-associated subarachnoid hemorrhage. J Clin Neurosci. 2013;20(6):824-826. doi: 10.1016/j.jocn.2012.07.015

14. Tung P, Kopelnik A, Banki N, Ong K, Ko N, Lawton MT, et al. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004;35(2):548-551. doi: 10.1161/01.STR.0000114874.96688.54

15. Claassen J, Albers D, Schmidt JM, De Marchis GM, Pugin D, Falo CM, et al. Nonconvulsive seizures in subarachnoid hemorrhage link inflammation and outcome. Ann Neurol. 2014;75(5):771-781. doi: 10.1002/ana.24166

16. Hammer A, Ranaie G, Erbguth F, Hohenhaus M, Wenzl M, Killer-Oberpfalzer M, et al. Impact of complications and comorbidities on the intensive care length of stay after aneurysmal subarachnoid haemorrhage. Sci Rep. 2020;10(1):6228. doi: 10.1038/s41598-020-63298-9

17. Naidech AM, Kreiter KT, Janjua N, Ostapkovich N, Parra A, Commichau C, et al. Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke. 2005;36(3):583-587. doi: 10.1161/01.STR.0000141936.36596.1e

18. Diringer MN, Bleck TP, Claude Hemphill J 3rd, Menon D, Shutter L, Vespa P, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15(2):211-240. doi: 10.1007/s12028-011-9605-9

19. Delcourt C, Sato S, Zhang S, Sandset EC, Zheng D, Chen X, et al. Intracerebral hemorrhage location and outcome among INTERACT2 participants. Neurology. 2017;88(15):1408-1414. doi: 10.1212/WNL.0000000000003771.

20. Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375(11):1033-1043. doi: 10.1056/NEJMoa1603460

21. de Oliveira Manoel AL, Goffi A, Marotta TR, Schweizer TA, Abrahamson S, Macdonald RL. The critical care management of poor-grade subarachnoid haemorrhage. Crit Care. 2016;20:21. doi: 10.1186/s13054-016-1193-9

22. Sprigg N, Flaherty K, Appleton JP, Al-Shahi Salman R, Bereczki D, Beridze M, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018;391(10135):2107-2115. doi: 10.1016/S0140-6736(18)31033-X

23. Meretoja A, Churilov L, Campbell BC, Aviv RI, Yassi N, Barras C, et al. The spot sign and tranexamic acid on preventing ICH growth--AUStralasia Trial (STOP-AUST): protocol of a phase II randomized, placebo-controlled, double-blind, multicenter trial. Int J Stroke. 2014;9(4):519-524. doi: 10.1111/ijs.12132

24. Liu J, Nie X, Gu H, Zhou Q, Sun H, Tan Y, et al. Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial. Stroke Vasc Neurol. 2021;6(2):160-169. doi: 10.1136/svn-2021-000942

25. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2,143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809-817. doi: 10.1016/S0140-6736(05)67214-5

26. van Donkelaar CE, Bakker NA, Veeger NJ, Uyttenboogaart M, Metzemaekers JD, Luijckx GJ, et al. Predictive factors for rebleeding after aneurysmal subarachnoid hemorrhage: rebleeding aneurysmal subarachnoid hemorrhage study. Stroke. 2015;46(8):2100-2106. doi: 10.1161/STROKEAHA.115.010037

27. Tang C, Zhang TS, Zhou LF. Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis. PLoS One. 2014;9(6):e99536. doi: 10.1371/journal.pone.0099536

28. Li Q, Yakhkind A, Alexandrov AW, Alexandrov AV, Anderson CS, Dowlatshahi D, et al. Code ICH: a call to action. Stroke. 2024;55(2):494-505. doi: 10.1161/STROKEAHA.123.043033