traumatic_subarachnoid_hemorrhage_complications

Traumatic subarachnoid hemorrhage complications

see Hydrocephalus after traumatic subarachnoid hemorrhage.

It is associated with a high incidence of cerebral vasospasm with a higher probability in patients with severe traumatic brain injury 1).

The presence of tSAH in cerebral contusion is also an independent predictor for hematoma progression 2) 3).

SAH has been reported in up to 60% of patients who have sustained a traumatic brain injury (TBI) and a significant predictor of death in patients with severe traumatic brain injury 4) 5) 6) 7) 8)

Prevention

Preventing complications in traumatic subarachnoid hemorrhage (tSAH) is crucial to improving outcomes and minimizing long-term disability. Key strategies focus on early detection, appropriate management, and addressing specific risks associated with tSAH. Here are the primary areas for preventing complications:

1. Preventing Secondary Brain Injury Maintain Optimal Blood Pressure: Avoid both hypotension (low blood pressure) and hypertension (high blood pressure). Use antihypertensive medications if needed to manage elevated blood pressure. Monitor and Manage Intracranial Pressure (ICP): Regularly monitor ICP and use measures like head elevation, osmotic diuretics (e.g., mannitol), and hyperventilation to control elevated ICP. Ensure Adequate Oxygenation and Perfusion: Maintain adequate oxygen levels and cerebral perfusion. Use supplemental oxygen and manage blood gases and glucose levels carefully. 2. Preventing Hydrocephalus Early Detection: Monitor for signs of hydrocephalus, such as changes in neurological status or increased ICP. Preventive Measures: In cases of suspected or early hydrocephalus, manage with appropriate interventions such as ventriculostomy or shunt placement to drain cerebrospinal fluid (CSF) and relieve pressure. 3. Preventing and Managing Vasospasm Nimodipine: Administer nimodipine, a calcium channel blocker, to reduce the risk of vasospasm and improve outcomes. Volume Expansion: Use hypervolemic therapy to increase blood volume and improve cerebral perfusion. Monitoring: Regularly monitor for signs of vasospasm using transcranial Doppler ultrasonography or other imaging techniques. Pharmacologic Therapy: Consider intra-arterial or systemic vasodilators in severe cases of vasospasm. 4. Preventing Seizures Prophylactic Antiepileptics: Administer antiepileptic drugs (AEDs) if there is a high risk of seizures, especially in the presence of cortical injury or previous seizure history. Monitoring: Regularly monitor for seizures and adjust medication as needed. 5. Preventing Infection Sterile Techniques: Use sterile techniques for any invasive procedures, such as placement of ventriculostomy or central lines. Antibiotics: Administer prophylactic antibiotics if indicated, especially if there is a risk of infection from invasive procedures. Hygiene: Ensure proper hygiene and infection control measures in the ICU and hospital settings. 6. Preventing Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Early Mobilization: Encourage early mobilization and physical therapy as soon as the patient’s condition allows. Prophylactic Anticoagulation: Use anticoagulants or mechanical prophylaxis (e.g., compression devices) to prevent DVT, particularly in immobile or high-risk patients. 7. Preventing Long-term Complications Rehabilitation: Initiate rehabilitation therapies (physical, occupational, speech) early to address motor, cognitive, and communication impairments. Psychological Support: Provide psychological support and counseling to address emotional and cognitive changes resulting from the injury. Regular Follow-up: Schedule regular follow-up appointments to monitor for delayed complications and adjust treatment as needed. 8. Patient and Family Education Education: Educate patients and families about the signs of potential complications and the importance of adhering to treatment plans. Support: Provide access to support services and resources for ongoing care and recovery. Summary Preventing complications in traumatic subarachnoid hemorrhage involves:

Effective management of blood pressure, ICP, and oxygenation to prevent secondary brain injury. Monitoring and treating hydrocephalus and vasospasm proactively. Preventing seizures and infections, and managing risks for DVT and PE. Providing rehabilitation and long-term support to address and manage long-term effects. By focusing on these areas, healthcare providers can improve patient outcomes and reduce the risk of severe complications associated with tSAH.

1)
Aminmansour B, Ghorbani A, Sharifi D, Shemshaki H, Ahmadi A. Cerebral vasospasm following traumatic subarachnoid hemorrhage. J Res Med Sci. 2009 Nov;14(6):343-8. PubMed PMID: 21772907; PubMed Central PMCID: PMC3129077.
2)
Chang EF, Meeker M, Holland MC. Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period. Neurosurgery. 2006:58647-58656.
3)
Chieregato A, Fainardi E, Morselli-Labate AM, et al. Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery. 2005;56:671-680 [discussion: 671-680].
4)
Zurynski YA, Dorsch NW. A review of cerebral vasospasm. Part IV. Post-traumatic vasospasm. J Clin Neurosci. 1998;146(2):146–54.
5)
Mattioli C, Beretta L, Gerevini S, Veglia F, Citerio G, Cormio M, et al. Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome. J Neurosurg. 2003;98(1):37–42.
6)
Eisenberg HM, Gary HE, Jr, Aldrich EF, Saydjari C, Turner B, Foulkes MA, et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg. 1990;73(5):688–98.
7)
Kakarieka A, Schakel EH, Fritze J. Clinical experiences with nimodipine in cerebral ischemia. J Neural Transm Suppl. 1994;43:13–21.
8)
Morris GF, Bullock R, Marshall SB, Marmarou A, Maas A, Marshall LF. Failure of the competitive N-methyl-Daspartate antagonist Selfotel (CGS 19755) in the treatment of severe head injury: results of two phase III clinical trials. The Selfotel Investigators. J Neurosurg. 1999;91(5):737–43.
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