SUBARACHNOID HEMORRHAGE


Usually tx'd with external ventricular drains

Cerebral vasospasm is common and can cause ischemic deficits after initial presentation; usually dx'd by transcranial doppler.  Tx's used to prevent this:

15-20% of pts with subarachnoid hemorrhage have delayed ischemic neurologic deficits ("DINDs") within 2wks of the SAH, due to vasospastic reaction.

In a study in 80 pts with aneurysmal subarachnoid hemorrhage randomized to pravastatin 40mg QD vs. placebo started within 72h of onset of symptoms and continued x 14d, the Pravastatin group had sig. lower incidence of DIND (5% vs. 30%) and sig. lower mortality (5% vs. 20%) (Stroke 36:1627, 2005--JW)