Diagnosis and therapy of the non-traumatic subarachnoid haemorrhage

Some 5-10% of all apoplectic strokes can be ascribed to subarachnoid haemorrhage (SAH), caused in 80% by the rupture of an intracranial aneurysm. Typical clinical signs are the sudden onset of a severe headache, often accompanied by meningism and focal neurological deficits or coma. Currently, standard therapy of SAH is "early intervention", so called, which includes surgical clipping of the aneurysm or endovascular intervention (coiling) within 72 hours of the haemorrhage. To prevent intra-operative rupture, deep anaesthesia during surgical or endovascular intervention is required, and arterial blood pressure should be adjusted to low normal values. In addition, during the surgical procedure the inspiratory oxygen concentration should be adjusted to 80-100% in preparation for possible temporary clipping. Where appropriate, post-interventional therapy includes oral application of nimodipine to prevent a possible delayed ischaemic neurological deficit (DIND) and induced hypertension. Hypervolaemia is no longer recommended, but normovolaemia and avoidance of hyperglycaemia are imperative. To be able to identify early neurological signs of DIND, analogsedation should be avoided wherever possible.