I60.0-9
DESCRIPTION
Bleeding into the subarachnoid space, most commonly due to the rupture of a vascular aneurysm. Patients typically present with an acute onset of severe headache and may have additional neurological symptoms and signs. Diagnosis is confirmed preferably by neurological imaging and, when this is not available, by demonstrating CSF xanthochromia on lumbar puncture.
GENERAL MEASURES
Maintain normal hydration and electrolyte status.
Control blood pressure.
MEDICINE TREATMENT
Analgesia if level of consciousness is not impaired:
- Paracetamol, oral, 1 g 4–6 hourly when required.
- Maximum dose: 15 mg/kg/dose.
- Maximum daily dose: 4 g in 24 hours.
If no response:
- Morphine, IV, to a total maximum dose of 10 mg (See Medicines, for individual dosing and monitoring for response and toxicity).
Avoid NSAIDs.
In all patients presenting with aneurysmal subarachnoid hemorrhage (SAH) while waiting for transfer to neurosurgical facility and in consultation with neurosurgeon:
- Nimodipine, oral, 60 mg 4 hourly for 21 days.
REFERRAL
All patients with minimal impairment of consciousness level for angiography and appropriate neurosurgical management. Patients initially deemed unsuitable for further investigation, may be referred at a later stage, should their condition improve.