Subarachnoid hemorrhage

Prevention
Article section 8 of 16.  Previous  Next

By Alejandro Hornik MD and James R Brorson MD

Smoking cessation, blood pressure control, and elimination of high-risk behaviors (cocaine and sympathomimetic use, heavy alcohol consumption) may help prevent aneurysm rupture (Bederson et al 2009). Education of physicians and the general public regarding signs and symptoms of subarachnoid hemorrhage might result in fewer misdiagnoses and earlier neurosurgical referral.

Familial clustering of aneurysms has been described, with studies demonstrating that first-degree relatives of patients with aneurysmal subarachnoid hemorrhage are between 2 and 5 times more likely to develop subarachnoid hemorrhage (Schievink 1997; Bor et al 2008). Screening for unruptured aneurysms may be useful in patients with 2 or more first-degree relatives with known aneurysms, though screening patients with only 1 first degree relative does not appear to be cost effective. In a decision analysis, 149 relatives of a patient with subarachnoid hemorrhage would need to be screened to prevent one subarachnoid hemorrhage and 298 would need to be screened to prevent one fatal subarachnoid hemorrhage (Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group 1999). According to the American Heart Association guidelines for 2009, screening of certain high-risk populations for unruptured aneurysms is of uncertain value (Bederson et al 2009).

Education of physicians and the general public regarding signs and symptoms of subarachnoid hemorrhage might result in fewer misdiagnoses and earlier neurosurgical referral. This may reduce the high morbidity and mortality associated with a catastrophic subarachnoid hemorrhage.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis
Management
Pregnancy
Anesthesia
References cited
Contributors