Medical Management of Hemorrhagic Stroke/Complications

Hemorrhagic stroke care is more focused on…

supportive

DAMAGE CONTROL

Medical and sx management of SAH aims to…

prevent and mitigate complications

Potential complications of SAH

Aneurysm rebleeding and cerebral vasospasm

How are aneurysms secured?

• Applying titanium CLIP

• Deploying platinum COALS

Goal = reduce blood flow to aneurysm

What is important to control in the early period after a SAH?

BLOOD PRESSURE → prevent rebleeding

• maintain <160

Manage BP while still considering risk of hypoperfusion

Why are patients at risk for ischemic stroke?

Blood pushing against vessels → bleeding makes our vessels constrict

Why is cerebral edema a complication?

inflammatory response

Cerebral vasospasm causes…

delayed ischemic neuro deficit

When does vasospasm typically occur

4 and 14 days after the SAH

Clinical manifestations of vasospasm

confusion

change in LOC

new local motor weakness (wax and wan)

Treatment of vasospasm

Hypertension

Hypervolemia

Hemodilution

Triple-H therapy → maintain patency while preventing infarction

How is Hypertension achieved

withholding antihypertensive meds

Vasoactive medsH

How is Hypervolemia achieved

Albumin

Intent of hemodilution

decrease viscosity of blood → allow it to travel through narrow space

What electrolyte imbalance is common in SAH

HYPOnatremia → SIADH