AHA 2012 aSAH guidlines Flashcards
(43 cards)
Time frame in which the risk of rebleeding is maximal?
the first 2-12 hours
Which has the worst outcome: early or late rebleeding?
early rebleeding is associated with worse outcome than later rebleeding
Factors associated with aneursym rebleeding? (6)
- longer time to aneurysm treatment
- worse neurological status on admission
- initial loss of consciousness
- previous sentinel headaches
- larger aneurysm size
- systolic BP > 160
Recommendations for BP control to prevent rebleeding after aSAH? (goal BP and what agents?)
The management of BP to reduce risk of rebleeding has not been established. Decrease to < 160 SBP (class IIa). Nicardipine and Clevidipine may give smoother control than labetalol and sodium nitroprusside
If there is a delay in obliteration of aneurysm and increased risk of rebleeding, what can be done in the interim (2)?
aminocaproic acid/tranexamic acid (decreased risk of bleed but 3mo outcome was unaffected, increased risk of DVT). NOT approved by FDA for prevention of aneursym rebleeding
Incidence of aSAH in the US?
9.7/100,000
What percent of patients with aSAH die before hospital admission?
12-15% of cases
Average of onset?
> /= 50 years of age
incidence in females vs males?
incidence in women is 1.24 times higher than in men
incidence by race?
Black and Hispanics have a higher incidence of aSAH than white Americans
behavioral risk factors for aSAH? (5)
- HTN
- smoker
- alcohol abuse
- use of sympathomimetic drugs (cocaine)
- diet/body mass index
other non-modifable risk factors? (6)
- female
- unruptured cerebral aneurysm
- hx of previous aSAH
- hx of familial aneurysms
- family history of aSAH
- certain genetic syndromes (ie ADPKD, type 4 Ehlers-Danlos, etc)
What factors increase risk of aneurysm rupture? (3)
- Location
- anterior circulation aneursyms rupture more in pts < 55 yrs
- PCOMM aneurysms rupture more in men
- basilar artery aneurysm rupture is associated with alcohol use - size > 7mm (smaller in pts with combination HTN and smoking)
- significant life events (ie financial or legal problems)
Does preganancy/delivery increase risk of rupture?
no
How can a statin and CCB be helpful in decreasing risk?
may retard aneurysm formation through inhibition of NF-kB and other pathways
What morphology characteristics are associated with rupture? (2)
- bottleneck shape
2. ratio of size of aneurysm to parent vessel
Who should be screened for aneurysms? (2)
familial aneurysm or 1st degree relative with aSAH
What are the results of the CARAT trial? (2)
Cerebral Aneurysm Rerupture After Txt. recurrent aSAH was (1) predicted by incomplete obliteration of the aneurysm (2) occurred a median of 3 days after treatment but rarely after 1 year
What is the median mortality rate for aSAH in the US?
32%
Mortality rate: women vs men? By race?
Higher mortality in women than in men. Higher mortality in blacks, American Indians, and Asians compared to whites.
Relationship between cognitive function and aSAH?
Cognitive fxn tends to improve over the first year, global cognitive impairment is present in ~20% of aSAH patients and is associated with poorer functional recovery and lower quality of life.
What is the strongest prognostic indicator for aSAH?
The severity of clinical presentation in the strongest prognostic indicator in aSAH?
What is the classic presentation of aSAH ? (what % of patients present with classic sx?) Other typical associated sx? (5)
worst headache of my life which 80% of pts p/w. Other classic sx include: N/V, stiff neck, photophobia, brief LOC, FND
% of patient that present with sentinel HA?
10-43% of patients
