Case Series Report: Subarachnoid Hemorrhage and ICU Management

Authors

  • Retnaningsih Neurology Department, Dr. Kariadi General Center Hospital Semarang, Indonesia, Indonesia
  • Dodik Tugasworo Neurology Department, Dr. Kariadi General Center Hospital Semarang, Indonesia, Indonesia
  • Yovita Andhitara Neurology Department, Dr. Kariadi General Center Hospital Semarang, Indonesia, Indonesia
  • Rahmi Ardhini Neurology Department, Dr. Kariadi General Center Hospital Semarang, Indonesia, Indonesia
  • Aditya Kurnianto Neurology Department, Dr. Kariadi General Center Hospital Semarang, Indonesia, Indonesia
  • Daynuri Neurology Program Study, Faculty of Medicine, Diponegoro University Semarang, Indonesia, Indonesia
  • Erlangga Pradipta Harianto Faculty of Medicine, Diponegoro University Semarang, Indonesia, Indonesia

DOI:

https://doi.org/10.36408/mhjcm.v10i3.745

Keywords:

Subarachnoid hemorrhage, aneurysm, vasospasm, early brain injury

Abstract

Background: Subarachnoid hemorrhage is a neurological syndrome with complex systemic complications. Rupture of an intracranial aneurysm causes acute extravasation of arterial blood under high pressure into the subarachnoid space and often into the brain parenchyma and ventricles. Bleeding triggers a complex series of events, which can ultimately lead to early brain injury, delayed cerebral ischemia, and systemic complications.

Cases: There were six cases of subarachnoid hemorrhage. Some patients come clinically with severe headache and loss of consciousness. The patient has been treated quickly and aggressively and even put on a ventilator for complications of respiratory failure, support for shock and management of aneurysm clipping and EVD. Rapid and precise diagnosis in the management of patients with SAH is of paramount importance, within the first few hours after the onset of SAH. The risk for early neurologic damage and high rates of severe long-term complications necessitated aggressive early management.

Conclusion: Rapid diagnosis and attentive management of patients with SAH are essential, as early deterioration is possible within the first few hours after the onset of SAH. The risk for early neurologic damage and high rates of severe long-term complications necessitated aggressive early management. Prevention and Management of Complications. The most common complications were pneumonia, aspiration, respiratory failure/distress, sepsis and imbalance electrolyte (hyponatremia). Approximately 50% of deaths after SAH are due to medical complications.

Downloads

Download data is not yet available.

References

1. Naidech AM, Janjua N, Kreiter KT, Ostapkovich ND, Fitzsimmons BF, Parra A, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. Arch Neurol. 2005;62(3):410–6.

2. 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 201. 2016 Jan 23;20(1):1–19.

3. Lehmann L, Bendel S, Uehlinger DE, Takala J, Schafer M, Reinert M, et al. Randomized, double-blind trial of the effect of fluid composition on electrolyte, acid-base, and fluid homeostasis in patients early after subarachnoid hemorrhage. Neurocrit Care. 2013 Feb;18(1):5–12.

4. Alimohamadi M, Saghafinia M, Alikhani F, Danial Z, Shirani M, Amirjamshidi A. Impact of electrolyte imbalances on the outcome of aneurysmal subarachnoid hemorrhage: A prospective study. Asian J Neurosurg. 2016 Mar;11(1):29.

5. Marupudi NI, Mittal S. Diagnosis and Management of Hyponatremia in Patients with Aneurysmal Subarachnoid Hemorrhage. J Clin Med. 2015 Apr 21;4(4):756.

6. Wilson RD. Mortality and Cost of Pneumonia After Stroke for Different Risk Groups. J Stroke Cerebrovasc Dis. 2012 Jan;21(1):61.

7. Claassen J, Vu A, Kreiter KT, Kowalski RG, Du EY, Ostapkovich N, et al. Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage. Crit Care Med. 2004 Mar;32(3):832–8.

8. Rivero Rodríguez D, Scherle Matamoros C, Cúe LF, Miranda Hernández JL, Pernas Sánchez Y, Pérez Nellar J. Predictor’s of mortality in patients with aneurysmal subarachnoid haemorrhage and reebleding. Neurol Res Int. 2015;2015.

9. Marcolini E, Hine J. Approach to the diagnosis and management of subarachnoid hemorrhage. West J Emerg Med. 2019;20(2):203–11.

10. Hop JW, Rinkel GJE, Algra A, Van Gijn J. Initial Loss of Consciousness and Risk of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. Stroke. 1999;30(11):2268–71.

11. Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology. 1998 May 1;50(5):1413–8.

12. Stegmayr B, Eriksson M, Asplund K. Declining Mortality From Subarachnoid Hemorrhage. Stroke. 2004 Sep 1;35(9):2059–63.

13. Lantigua H, Ortega-Gutierrez S, Schmidt JM, Lee K, Badjatia N, Agarwal S, et al. Subarachnoid hemorrhage: who dies, and why? Crit Care. 2015 Aug 31;19(1).

14. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage. Cerebrovasc Dis. 2013;35(2):93–112.

15. Dey M, Jaffe J, Stadnik A, Awad IA. External Ventricular Drainage for Intraventricular Hemorrhage. Curr Neurol Neurosci Rep. 2012 Feb;12(1):24.

16. Rosen RD, Sapra A. TNM Classification. StatPearls NCBI. 2022 Feb 17;

17. Martin-Schild S, Albright KC, Tanksley J, Pandav V, Jones EB, Grotta JC, et al. Zero on the NIHSS Does NOT Equal the Absence of Stroke. Ann Emerg Med. 2011 Jan;57(1):42.

18. Ding R, Logemann JA. Pneumonia in stroke patients: A retrospective study. Dysphagia. 2000 Apr 1;15(2):51–7.

19. Perrini P, Montemurro N, Caniglia M, Lazzarotti G, Benedetto N. Wrapping of intracranial aneurysms: Single-center series and systematic review of the literature.. 2015 Nov 2;29(6):785–91.

20. Saber Tehrani AS, Kattah JC, Kerber KA, Gold DR, Zee DS, Urrutia VC, et al. Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls. Stroke. 2018;49(3):788.

Additional Files

Published

2023-11-29

How to Cite

1.
Retnaningsih, Tugasworo D, Andhitara Y, Ardhini R, Kurnianto A, Daynuri, Harianto EP. Case Series Report: Subarachnoid Hemorrhage and ICU Management. Medica Hospitalia J. Clin. Med. [Internet]. 2023 Nov. 29 [cited 2024 May 15];10(3):370-6. Available from: http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/745

Issue

Vol. 10 No. 3 (2023): Med Hosp; Nov 2023

Section

Case Report

Citation Check

License

Copyright (c) 2023 Retnaningsih, Dodik Tugasworo, Yovita Andhitara, Rahmi Ardhini, Aditya Kurnianto, Daynuri, Erlangga Pradipta Harianto

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyrights Notice
Copyrights:
Researchers publishing manuscrips at Medica Hospitalis: Journal of Clinical Medicine agree with regulations as follow:
Copyrights of each article belong to researchers, and it is likewise the patent rights
Researchers admit that Medica Hospitalia: Journal of Clinical Medicine has the right of first publication
Researchers may submit manuscripts separately, manage non exclusive distribution of published manuscripts into other versions (such as: being sent to researchers’ institutional repository, publication in the books, etc), admitting that manuscripts have been firstly published at Medica Hospitalia: Journal of Clinical Medicine
License:
Medica Hospitalia: Journal of Clinical Medicine is disseminated based on provisions of Creative Common Attribution-Share Alike 4.0 Internasional It allows individuals to duplicate and disseminate manuscripts in any formats, to alter, compose and make derivatives of manuscripts for any purpose. You are not allowed to use manuscripts for commercial purposes. You should properly acknowledge, reference links, and state that alterations have been made. You can do so in proper ways, but it does not hint that the licensors support you or your usage.