SAH Management Algorithm



  • In our practice, we prefer to start seizure prophylaxis in the setting of an unsecured aneurysm to abate potential deleterious effects of seizures on an already dysregulated brain. (N.B. We prefer agents other than phenytoin.)
  • The 2012 American Stroke Association guidelines suggest that a decrease in systolic blood pressure to <160mm Hg is reasonable, but in our clinical practice,  we keep the systolic blood pressure <140mm hg to further lower the risk of aneurysmal rerupture, as long as the patient is alert and CPP is adequate.

pdf file: nrneurol.2013.246-pf1


Macdonald, R. Loch. “Delayed Neurological Deterioration After Subarachnoid Haemorrhage”. Nature Reviews Neurology 10.1 (2013): 44-58.



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