Neurological Emergencies—Now What Do You Do?

So you've diagnosed the subarachnoid hemorrhage, now what do you do?

You call your neurosurgeon pronto. This is a neurosurgical emergency, requiring immediate hospitalization.

But wait a minute, your Hunt & Hess SAH grade 1 patient tells you, I feel fine. Why can't I go home and see this guy in the morning.

Well, why can't he?

Well, what are the complications of SAH? Hmmm?

Complications of SAH include:

rebleeding, which occurs in the first 24-48 hours ( and is about 30% fatal)
hydrocephalus, which may occur within the first 12-24 hours and can be fatal
delayed ischemic deficit (AKA vasospasm) which commences around 4 days post-bleed and can be fatal

Thus, prudence dictates admission and close followup.

Realize that there is considerable controversy in the neurosurgical community over whether these things should be operated on right away, delayed, GDC coiled and delayed, etc. If you want to start a lively conversation, go to the next neurosurgical convention, get invited to a cocktail party, and ask one neurosurgeon in the presence of another, "What do you do with a fresh SAH"