Title |
Review and recommendations on management of refractory raised intracranial pressure in aneurysmal subarachnoid hemorrhage
|
---|---|
Published in |
Vascular Health and Risk Management, July 2013
|
DOI | 10.2147/vhrm.s34046 |
Pubmed ID | |
Authors |
George Wong, Mak, Gabriel Lu Yeow Yuen |
Abstract |
Intracranial hypertension is commonly encountered in poor-grade aneurysmal subarachnoid hemorrhage patients. Refractory raised intracranial pressure is associated with poor prognosis. The management of raised intracranial pressure is commonly referenced to experiences in traumatic brain injury. However, pathophysiologically, aneurysmal subarachnoid hemorrhage is different from traumatic brain injury. Currently, there is a paucity of consensus on the management of refractory raised intracranial pressure in spontaneous subarachnoid hemorrhage. We discuss in this paper the role of hyperosmolar agents, hypothermia, barbiturates, and decompressive craniectomy in managing raised intracranial pressure refractory to first-line treatment, in which preliminary data supported the use of hypertonic saline and secondary decompressive craniectomy. Future clinical trials should be carried out to delineate better their roles in management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage patients. |
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