Rebleeding and vasospasm after SAH: New strategies for improving outcome

Rebleeding and cerebral vasospasm are major causes of death and disability in SAH patients. Early surgery is used to prevent rebleeding. However, because the risk of this complication is highest during the first 24 hours, prophylaxis with an antifibrinolytic, bed rest, and antihypertensive therapy may be helpful between presentation and surgery. Angiography and transcranial Doppler ultrasonography can be used to detect cerebral vasospasm. An increase in cerebral blood flow velocity of at least 50 cm/s during one 24-hour period or a mean velocity of 120 cm/s is predictive of symptomatic vasospasm, which carries a 15% to 20% risk of stroke or death. Hypervolemia, induced hypertension, hemodilution, and nimodipine are used to prevent and/or treat cerebral vasospasm.