A Brief Note On The Role Of Intervention

2311 WordsNov 25, 201610 Pages
VASOSPASM IN SUBARACHNOID HAEMMORHAGE The Role of Intervention INTRODUCTION Subarachnoid haemorrhage (SAH), is a significant healthcare problem. It is associated with significant mortality and morbidity even after adequate treatment has been delivered. One of the major causes for this poor outcome is the development of vasospasm from the pathophysiological process itself. For those patients who have survived the initial bleed, it remains a challenge to ward off the effects of vasospasm. Various interventional and medical strategies have been advanced to alleviate or minimise the effect of vasospasm, but are they really effective? An attempt at answering this question will be made in this review of this terrible and life threatening illness. CASE A 40 yo female presented to the emergency department of our institution with a two hour history of a sudden onset of severe global headaches. This was associated with two episodes of vomiting and photophobia. She had no complaints of loss of consciousness or lateralising weakness. On examination she had a Glasgow Coma Score (GCS) of 15 with no neurological deficits. A non contrast Computed Tomography (CT) Brain (Fig1) showed extensive subarachnoid blood in the Sylvian fissure and basal cisterns. A CT angiogram showed a left posterior communicating (PCOM) artery aneurysm. The patient was commenced on Nimodipine , intravenous crystalloids, blood pressure control by titration with hydrallazine. A digital subtraction
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