Abstract
Despite availability of sophisticated surgical procedures, endovascular techniques and new trends in neuro-intensive care, treatment outcomes in patients with subarachnoid bleeding from a ruptured aneurysm are still very unsatisfactory. The first step in patient management, i.e. treating the source of bleeding, is followed by close patient monitoring, taking into account the natural course of the disease.
Cerebral vasospasms are among the most severe complications, identified in 40-70% of patients after subarachnoid bleeding. In patients in whom the source of bleeding has been treated, cerebral vasospasms are responsible for the development of delayed cerebral ischemia, the most common cause of high morbidity rates or deaths (15-20%).
Effective prevention of such complications is based on detailed clinical observation. Invasive monitoring of cerebral metabolism and intracranial pressure is to be applied in patients with impaired consciousness in order to detect a threatening cerebral ischemia as early as possible.
Current knowledge and technology enable more aggressive treatment that concentrates on normalising perfusion in the brain.