11. tbl. 107. árg. 2021

Critical care management of patients with spontaneous subarachnoid haemorrhage – a review

Meðferð gjörgæslusjúklinga með sjálfsprottnar innanskúmsblæðingar - yfirlitsgrein


Eyrún Arna Kristinsdóttir1

Sigrún Ásgeirsdóttir1

Halldór Skúlason2

Aron Björnsson2

Vilhjálmur Vilmarsson3

Kristinn Sigvaldason1



1Department of Anaesthesia, 2Department of Brain Surgery, 3Department of Radiology, Landspitali University Hospital.

Correspondence: Kristinn Sigvaldason, krisig@landspitali.is

Key words: Subarachnoid hemorrhage, vasospas, poyuria,
hyponatremia, critical care treatment, rebleeding.


Spontaneous subarachnoid haemorrhage is characterized by extravasation of blood into the subarachnoid space without a preceding trauma. The leading cause is a ruptured intracranial aneurysm. Serious neurologic complications can occur, such as rebleeding, cerebral vasospasm and delayed cerebral ischemia. Subarachnoid haemorrhage is a serious condition with a high mortality rate and those who survive often suffer long-term consequences. Prevention of rebleeding by aneurysm repair is essential and guidelines recommend this procedure should be done as soon as possible or within 72 hours. Management requires intensive care with emphasis on accurate blood pressure control, maintaining normal fluid and electrolyte balance and monitoring the level of consciousness. All patients should be treated with the calcium channel blocker nimodipine to reduce the risk of vasospasm and delayed cerebral ischemia which are among the most serious complications of subarachnoid haemorrhage.

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