This is a very late #WeekendLecture
but you can review it anytime you want😉
🧠#Aneurysm & #Subarachnoid Hemorrhage
Unruptured intracranial aneurysms are pathologic dilations at major branching brain arteries
~3% of adult population
nejm.org/doi/full/10.10…
thelancet.com/journals/lance…
#WeekendLecture
#Aneurysms & #SAH
The most common presentation of intracranial aneurysm is rupture leading to #SAH
The risk of rupture depends on patient and aneurysm related factor, ie: age/gender/location/size/growth, etc
🧠ahajournals.org/doi/10.1161/ST…
🧠journals.lww.com/continuum/Abst…
#WeekendLecture
#Aneurysms & #SAH
It is well known that endovascular or neurosurgical management of #unruptured intracranial aneurysm is not free of procedural #complications
This study investigates risk factors for this complications @JAMANeuro
👇
jamanetwork.com/journals/jaman…
#WeekendLecture
#Aneurysms & #SAH
The hallmark presenting symptom of #aSAH is “the worst headache of my life”
The onset is sudden, headache is severe and reaches maximal intensity in seconds👉 #thunderclap headache
@NEJM check the interactive graphic⤵️
nejm.org/doi/full/10.10…
#WeekendLecture
#Aneurysms & #SAH
#NCCT is the 1st #diagnostic test
If CT is (-), next step should be lumbar puncture
If imaged on 3rd-gen CT, < 6h of onset in a neurologically intact pt & interpreted as normal by a neurorx, SAH is r/o and no further investigations are necessary
#WeekendLecture
#Aneurysms & #SAH
The strategies to minimize brain damage after #aSAH:
-⏬acute 🧠injury and #ICP:
👉hydrocephalus
👉🧠edema
-Prevent #rebleeding
-Minimize delayed ischemia #DCI, from #vasospasm and other factors
sciencedirect.com/science/articl…
#WeekendLecture
#Aneurysms & #SAH
Preventing #rebleeding (~13%)may be achieved by treating acute HTN, #repairing the aneurysm as soon as possible, and maybe administering #antifibrinolytic drugs
#ULTRA early tranexamic acid trial did not improve 6m mRS 😕
thelancet.com/journals/lance…
#WeekendLecture
#Aneurysms & #SAH
Repairing aneurysm can be perform by #endovascular techniques or #neurosurgical clipping
@CochraneStroke @cochranecollab @IST_3
cochranelibrary.com/cdsr/doi/10.10…
#WeekendLecture
#Aneurysms & #SAH
We have learned that #aSAH is not just an intracranial disease
Early brain injury can induce #cardiac disfunction an #pulmonary edema
#Neurocritical care aims for this global approach
nature.com/articles/nrneu…
#WeekendLecture
#Aneurysms & #SAH
#neurotwitter
There has been an improvement in #aSAH based on best #neurocritical care, #guidelines, #system of care and experience:
👉ahajournals.org/doi/10.1161/ST…
👉ahajournals.org/doi/10.1161/st…
👉higherlogicdownload.s3.amazonaws.com/NEUROCRITICALC…
Thank you!
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